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Kunioka S, Suzuki F, Nagata M, Tsutsui M, Kamiya H. A Rare Case of Leukemoid Reaction During Mechanical Circulatory Support in a Patient With Severe Heart Failure: An Autopsy Study. Cureus 2024; 16:e54603. [PMID: 38524048 PMCID: PMC10958757 DOI: 10.7759/cureus.54603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
The leukemoid reaction (LR) is reported to be caused by severe stress conditions such as infection, malignancies, intoxication, severe hemorrhage, or acute hemolysis; this condition is attributed to a very severe prognosis. Some reports have suggested that the LR was associated with a systemic stress response. A 36-year-old man who required mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation and Impella 5.5 due to severe heart failure, was transferred to our hospital. He showed a markedly elevated WBC count and died of multiple organ failure. The autopsy revealed the possibility that leukocytosis might have been due to an LR; however, the cause of the cardiac failure was unknown. To the best of our knowledge, this study is the first to report a rare case of LR in a patient with severe heart failure requiring MCS.
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Affiliation(s)
- Shingo Kunioka
- Intensive Care Unit/Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Fumitaka Suzuki
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | | | | | - Hiroyuki Kamiya
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
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2
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Viner E, Berger J, Bengualid V. Etiologies of Extreme Leukocytosis. Cureus 2023; 15:e38062. [PMID: 37228523 PMCID: PMC10208012 DOI: 10.7759/cureus.38062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/02/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the etiologies and co-morbidities associated with extreme leukocytosis, which is characterized by a white blood cell (WBC) count ≥ 35 × 109 leukocytes/L. Method: Retrospective chart review was conducted for all patients, aged 18 years and older, admitted to the internal medicine department between 2015 and 2021 with an elevated WBC count ≥ 35 × 109 leukocytes/L within the first 24 hours of admission. Results: Eighty patients were identified to have WBC count ≥ 35 × 109 leukocytes/L. The overall mortality was 16% and increased to 30% in those presenting with shock. Mortality increased from 2.8% in patients with WBC count in the range of 35-39.9 × 109 leukocytes/L to 33% in those with WBC count in the range of 40-50 × 109 leukocytes/L. There was no correlation with underlying co-morbidities or age. Pneumonia was the most common infection (38%), followed by UTI or pyelonephritis (28%) and abscesses (10%). There was no predominant organism responsible for these infections. The most common etiology for WBC count between 35-39.9 × 109 leukocytes/L and 40-50 × 109 leukocytes/L was infections, while malignancies (especially chronic lymphocytic leukemia) were more common with WBC count > 50 × 109 leukocytes/L. Conclusion: For WBC counts in the range of 35-50 × 109 leukocytes/L, infections were the main reason for admission to the internal medicine department. Mortality increased from 2.8% to 33% as WBC counts increased from 35-39.9 × 109 leukocytes/L to 40-50 × 109 leukocytes/L. Overall, mortality for all WBC counts ≥ 35 × 109 leukocytes/L was 16%. The most common infections were pneumonia, followed by UTI or pyelonephritis and abscesses. The underlying risk factors did not correlate with WBC counts or mortality.
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Affiliation(s)
- Esther Viner
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Judith Berger
- Infectious Diseases, St. Barnabas Hospital (SBH) Health System, New York City, USA
| | - Victoria Bengualid
- Infectious Diseases, St. Barnabas Hospital (SBH) Health System, New York City, USA
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3
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Hasjim BJ, Grigorian A, Stopenski S, Swentek L, Sun B, Livingston JK, Williams B, Nastanski F, Nahmias J. Moderate to severe leukocytosis with vasopressor use is associated with increased mortality in trauma patients. J Intensive Care Soc 2022; 23:117-123. [PMID: 35615240 PMCID: PMC9125442 DOI: 10.1177/1751143720975316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Background Leukocytosis is a rise in white blood cell (WBC) count and clinical outcomes of moderate to severe leukocytosis in trauma patients have not been described. We hypothesized that trauma patients with severe leukocytosis (SL; ≥40.0 × 109 leukocytes/L) have higher rates of in-hospital complications and mortality than those with moderate leukocytosis (ML; 25.0-39 × 109 leukocytes/L). Methods We performed a retrospective analysis (2010-2017) on trauma patients developing ML or SL at a single Level-I trauma center. A multivariable logistic regression analysis for risk factors were performed. Results From 15,807 trauma admissions, 332 (2.1%) had ML or SL. Of these, 308 (92.8%) were ML and 24 (7.2%) were SL. Patients with ML and SL reached their peak WBC count in 1 and 10 days after admission respectively (p < 0.001). SL patients suffered higher rates of in-hospital complications (p < 0.05) and mortality compared to those without ML or SL (14.5% vs. 3.3%, p < 0.001). Between ML and SL, mortality rates rose with leukocytosis severity (13.3% vs. 29.2%, p = 0.03). Among all patients with ML or SL, vasopressor use was the strongest independent risk factor for mortality (OR 12.61, p < 0.001). Conclusion Clinicians should be weary of the increased mortality rates and in-hospital complications in SL patients. Among patients with ML or SL, vasopressor use, rather than SL, was the strongest predictor of mortality. Patients with ML had a quicker time course to peak leukocytosis compared to SL, suggesting these two entities to be distinct in etiology and outcome, warranting future research.
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Affiliation(s)
- Bima J Hasjim
- Department of Surgery, Division of
Trauma, Burns and Surgical Critical Care, University of California, Irvine,
Orange, USA
| | - Areg Grigorian
- Department of Surgery, Division of
Trauma, Burns and Surgical Critical Care, University of California, Irvine,
Orange, USA
| | - Stephen Stopenski
- Department of Surgery, Division of
Trauma, Burns and Surgical Critical Care, University of California, Irvine,
Orange, USA
| | - Lourdes Swentek
- Department of Surgery, Division of
Acute Care Surgery, Loma Linda University, Loma Linda, USA
| | - Beatrice Sun
- Department of Surgery, Stanford
University, Stanford, USA
| | | | - Barbara Williams
- School of Medicine, University of
California, Irvine, Irvine, USA
| | - Frank Nastanski
- Department of Surgery, Division of
Trauma, Burns and Surgical Critical Care, University of California, Irvine,
Orange, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of
Trauma, Burns and Surgical Critical Care, University of California, Irvine,
Orange, USA
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Ziccardi C, Cohn LA, Janacek B, Gross J, Nafe L, Grobman M. Etiology and outcome of extreme neutrophilic leukocytosis: A multi-institutional retrospective study of 269 dogs. J Vet Intern Med 2022; 36:541-548. [PMID: 35043992 PMCID: PMC8965212 DOI: 10.1111/jvim.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Background The magnitude of diagnostic abnormalities can influence the perception of clinical outcome. Extreme neutrophilic leukocytosis (ENL) is an uncommon finding caused by markedly increased granulopoiesis. A lack of recent, large‐scale studies limits our understanding of the importance, causation, and prognosis associated with ENL in dogs. Hypothesis/Objectives Describe disease categories (DC) identified in dogs with ENL and identify variables associated with survival. We hypothesized that factors including fever, segmented and band neutrophil counts, and DC would be negatively associated with survival. Animals Two‐hundred sixty‐nine dogs with ENL (segmented neutrophils ≥50 × 103 cells/μL) presented to the veterinary teaching hospitals at Auburn University (n = 164), the University of Missouri (n = 81), and Oklahoma State University (n = 24) between January 1, 2009 and December 31, 2019. Methods Retrospective study. Demographic data and outcome variables including temperature, CBC findings, DC, duration of hospitalization (DOH) and outcome were acquired from the medical record. Statistical analyses included chi‐squared and Kruskal‐Wallis tests, and Pearson product moment correlations with a P < .05 significance level. Results Mortality was 41%. Survival differed with DC (P = .002). Mortality was higher (P < .05) in dogs with neoplasia (56.2%) vs immune‐mediated disease (20.5%) or tissue damage/necrosis (19%). Weight (P = .001, r = −0.14) and total neutrophil count (P = .04, r = −0.02) were weakly negatively associated with survival whereas DOH was weakly positively associated with survival (P = .03, r = 0.14). Conclusions and Clinical Importance Mortality in dogs with ENL is high but differed according to DC. Only weak correlations between clinical or clinicopathologic variables and mortality were identified. Extreme neutrophilic leukocytosis should be interpreted in conjunction with the underlying disease process, and not broadly used to predict clinical outcome.
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Affiliation(s)
- Christianna Ziccardi
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Leah A Cohn
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Blakeley Janacek
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Jacklyn Gross
- Department of Veterinary Clinical Sciences, Oklahoma State University College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Laura Nafe
- Department of Veterinary Clinical Sciences, Oklahoma State University College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Megan Grobman
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
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5
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Hongwei H. Leukemoid reaction with severe thrombocytopenia in a dying patient: a case report and literature review. J Int Med Res 2021; 49:300060520974257. [PMID: 33423588 PMCID: PMC7804355 DOI: 10.1177/0300060520974257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the case of a 28-year-old healthy female without exceptional past medical history, who suffered from severe vaginal infection, is reported. Although symptoms improved, the white blood cell (WBC) count continued to increase up to 78 460 cells/µl, however, the patient continued to improve and the outcome was good. The case revealed that an increasing WBC count may not change in synchrony with clinical symptoms. When faced with this scenario, procalcitonin measurements may play an important role in differentiating diagnosis and guiding treatment.
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Affiliation(s)
- Huang Hongwei
- Intensive Care Unit, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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6
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Bingham E, Conner B, Stern J, Vitalo A, Schaer M. A 7-week-old male Golden Retriever with extreme leukocytosis: A case report. Clin Case Rep 2020; 8:3498-3502. [PMID: 33363959 PMCID: PMC7752618 DOI: 10.1002/ccr3.3464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 11/11/2022] Open
Abstract
Although neoplasia should be a top concern for extreme leukocytosis in dogs, infectious causes must also be considered to avoid delays in treatment or undue recommendations for humane euthanasia. Blood film review is of paramount importance.
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Affiliation(s)
- Emily Bingham
- University of Florida College of Veterinary MedicineGainesvilleFLUSA
| | - Bobbi Conner
- Virginia‐Maryland Regional College of Veterinary MedicineBlacksburgVAUSA
| | - Jere Stern
- University of Florida College of Veterinary MedicineGainesvilleFLUSA
| | - Amber Vitalo
- University of Florida College of Veterinary MedicineGainesvilleFLUSA
| | - Michael Schaer
- University of Florida College of Veterinary MedicineGainesvilleFLUSA
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7
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A prospective study of hospitalized patients with leukemoid reaction; causes, prognosis and value of manual peripheral smear review. ACTA ACUST UNITED AC 2020; 57:241-247. [PMID: 30862764 DOI: 10.2478/rjim-2019-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such as the percentage of band cells or grading of neutrophil toxic changes) has not been studied previously. METHODS We prospectively recorded all hospitalized adult (> 18 years old) patients with LR (≥ 30000/ul) of neutrophilic predominance, excluding patients with pre-existing leukocytosis due to hematological malignancies. We examined the diagnoses and prognosis (in-hospital mortality and post-discharge mortality up to a year after the end of the study) of these patients as well as the value of manual peripheral smear review. RESULTS We recorded a total of 93 patients with LR from January 2017 to December 2017. Infection was the most common diagnosis (70%), followed by malignancy (7.5%) and bleeding (6.5%). In-hospital mortality (45%) and post-discharge mortality (35% of those discharged) were very high. Among blood smear findings, only neutrophil vacuolation was significantly more common in patients with infections (34%), although it was also observed in many patients without any infection (13%). Blood smear findings were not associated with prognosis. CONCLUSION Detailed manual smear review is a labor-intensive procedure and it has limited diagnostic and prognostic value in unselected hospitalized patients with neutrophilic LR.
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8
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Portich JP, Faulhaber GAM. Leukemoid reaction: A 21st-century cohort study. Int J Lab Hematol 2019; 42:134-139. [PMID: 31765058 DOI: 10.1111/ijlh.13127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes. METHODS This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan-Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death. RESULTS Of the 267 cases with white blood cell count of >50 × 109 , 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log-rank [Mantel-Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death. CONCLUSIONS This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.
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Affiliation(s)
- Júlia P Portich
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gustavo A M Faulhaber
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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9
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Hoofien A, Yarden-Bilavski H, Ashkenazi S, Chodick G, Livni G. Leukemoid reaction in the pediatric population: etiologies, outcome, and implications. Eur J Pediatr 2018; 177:1029-1036. [PMID: 29696475 DOI: 10.1007/s00431-018-3155-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Leukemoid reaction (WBC > 30,000/μL) may indicate significant medical conditions, mostly infectious. Prompted by the lack of population-based data on the presentation, characteristics, and necessary workup in children with leukemoid reaction, we searched the database of a tertiary pediatric medical center for all children presented with at least one WBC count of ≥ 30,000/μL in 2009-2014. Demographic, clinical, and laboratory parameters were recorded. Children admitted with WBC < 30,000/μL served as controls. Pneumonia was the most common diagnosis in the leukemoid reaction group, with a 5.5-fold higher prevalence of pleuropneumonia than in the control group. The leukemoid group had a longer average hospital stay (7.5 vs. 5.5 days). Patients with WBC ≥ 50,000/μL had a sixfold higher rate of leukemia than patients with a lower count. There was a significant association of leukemia with low platelet count, low levels of C-reactive protein, and high levels of uric acid and lactate dehydrogenase. CONCLUSION Children presented with a leukemoid reaction are at high risk of pneumonia, especially pleuropneumonia, and a long hospital stay. Those with WBC ≥ 50,000/μL have a sixfold higher risk of leukemia. For prompt diagnosis, clinicians should be aware of the variables associated with leukemia. What is Known: • Leukemoid reaction has been associated with infectious diseases. • Leukemoid reaction at presentation in adults is correlated with high morbidity and mortality. What is New: • Children with leukemoid reaction are at high risk of pleuropneumonia. • We did not observe increased mortality in children with a leukemoid reaction.
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Affiliation(s)
- Assaf Hoofien
- Department of Pediatrics A and Unit of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 4920235, Petah Tikva, Israel
| | - Havatzelet Yarden-Bilavski
- Department of Pediatrics A and Unit of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 4920235, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Department of Pediatrics A and Unit of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 4920235, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Department of Pediatrics A and Unit of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 4920235, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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10
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Lioni A, Zorzou MP, Kollia C, Loulakis D, Ntziora F, Stergiou F, Boboli M, Chini M. Syphilis infection in an HIV patient presenting with leukemoid reaction: Case report and review of the literature. Infect Dis Rep 2018; 10:7410. [PMID: 29721241 PMCID: PMC5907733 DOI: 10.4081/idr.2018.7410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022] Open
Abstract
Leukemoid reaction (LR) is an uncommon though dreadful sign for the treating physician, as it is related to increased mortality. In the few series that have addressed its incidence and clinical significance, infectious causes count for about half of the cases of LR, the rest accounting for cancer, drugs or rarer causes. In the HIV setting, it represents an even rarer event, owing probably to the impaired granulocytic response of AIDS patients to bacterial agents. However no report exists as to the incidence of LR to the immune-restored HIV patients adequately treated with antiretroviral therapy (ART). Syphilis is a well known cause of mild lymphocytosis, though only one report of LR exists in the congenital setting. We hereby report a case of an HIV patient adequately treated with ART, who presented with LR with a lymphomonocytic preponderance after infection with treponema pallidum.
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Affiliation(s)
| | | | - Christina Kollia
- Internal Medicine Department Red Cross Hospital Korgialeneio Benakeio, Athens, Greece
| | - Dimitrios Loulakis
- Internal Medicine Department Red Cross Hospital Korgialeneio Benakeio, Athens, Greece
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Abstract
Herein, we report a case of a 12-year-old girl who presented with diabetic ketoacidosis and a leukemoid reaction. Although this association has been described in a few adult patients, pediatric cases have not been reported. A leukemoid reaction is commonly defined as an elevation in the white blood cell count greater than 50,000/μL in response to severe illness or stress other than hematologic malignancy; it is considered to be mediated by various hormones, cytokines, and factors that are released in response to inciting triggers, such as acidosis. As highlighted in our report, distinguishing a benign leukemoid reaction from a hematologic malignancy and even tumor lysis syndrome, particularly in a setting of diabetic ketoacidosis, is crucial to ensuring safe and efficacious therapeutic interventions.
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12
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[Relevance of eosinopenia as marker of sepsis in the Emergency Department]. Rev Med Interne 2016; 37:730-734. [PMID: 27032483 DOI: 10.1016/j.revmed.2016.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/17/2016] [Accepted: 02/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies in internal medicine departments and in intensive care units have shown the interest of eosinopenia in the diagnosis of infected patients. The aim of the present study was to test the value of this marker in the Emergency Department (ED), either alone or associated with other common sepsis markers. METHODS We report on a retrospective and monocentric study. We reviewed the complete blood count (CBC) of all patients visiting the ED during one-week duration (in February 2014). Every element of the CBC and other inflammation markers (such as CRP) were analyzed. RESULTS During the week of our study, 725 patients had a CBC (33 exclusions) and 692 patients were included for analysis. The median age was 59 years (IQR: 16-100). One hundred and twenty-five patients (18.1%) had a sepsis. The ROC curve demonstrated a cut off level of 10/mm3 eosinophils for which the specificity for sepsis was 91%. The association of eosinopenia (< 10/mm3) and white blood cells (WBC) or CRP elevation also showed a good specificity in patients with sepsis. CONCLUSION In the ED, with a "simple" CBC, a profound eosinopenia appears to be very specific for sepsis, alone or in association with other markers of inflammation. Eosinopenia may become a helpful tool in our daily practice in the ED. Further studies are needed to further evaluate this marker.
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Thachil J, Owusu-Ofori S, Bates I. Haematological Diseases in the Tropics. MANSON'S TROPICAL INFECTIOUS DISEASES 2014. [PMCID: PMC7167525 DOI: 10.1016/b978-0-7020-5101-2.00066-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Potasman I, Grupper M. Leukemoid reaction: spectrum and prognosis of 173 adult patients. Clin Infect Dis 2013; 57:e177-81. [PMID: 23994818 DOI: 10.1093/cid/cit562] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prognosis of patients with leukemoid reaction (LR) depends mainly on their underlying illness. Our aim was to investigate the etiologies and prognosis of a mixed group of patients with LR. METHODS We identified 173 patients who had ≥30.0 × 10(9) leukocytes/µL without hematologic malignancies. Causes of LR and factors contributing to death were analyzed. RESULTS Patients with LR constituted 0.59% of all admitted adults. The median age was 75 years, but 20 patients were aged <40 years. There was no difference in LR prevalence by gender (female/male = 88/85). Average white blood cell (WBC) count was 37.7 × 10(9)/µL. Fourteen patients (8.0%) had a WBC count of >50.0 × 10(9)/µL. The median duration of LR was 1 day, but 39 patients had prolonged LR (>1 day). Infection was the most common cause of LR (n = 83, 47.9%; 95% confidence interval, 40.7-55.4), followed by ischemia/stress (27.7%), inflammation (6.9%), and obstetric diagnoses (6.9%). Higher WBC counts were significantly associated with positive blood cultures (P = .017) or a positive Clostridium difficile toxin (P = .001). Antibiotics were prescribed for 140 patients (80.9%). Sixty-six patients (38.1%) died during hospitalization. Those with prolonged LR had an in-hospital mortality rate of 61.5%. Factors found to be highly correlated with death were age (odds ratio [OR] = 1.051, P < .001), any infectious diagnosis (OR = 2.574, P = .014), and sepsis (OR = 3.752, P = .001). CONCLUSIONS LR carries a grave prognosis, especially among the elderly and those with sepsis. LR was found to have multiple etiologies including infections, stress, inflammation, and obstetric diagnoses.
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Affiliation(s)
- Israel Potasman
- Infectious Diseases Unit, Bnai Zion Medical Centre and the Rappaport Faculty of Medicine, Technion, Haifa, Israel
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15
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Sukthana Y, Mahittikorn A, Wickert H, Tansuphaswasdikul S. A promising diagnostic tool for toxoplasmic encephalitis: tachyzoite/bradyzoite stage-specific RT-PCR. Int J Infect Dis 2012; 16:e279-84. [DOI: 10.1016/j.ijid.2011.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/17/2011] [Accepted: 12/05/2011] [Indexed: 11/25/2022] Open
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16
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Asadollahi K, Hastings IM, Gill GV, Beeching NJ. Prediction of hospital mortality from admission laboratory data and patient age: A simple model. Emerg Med Australas 2011; 23:354-63. [DOI: 10.1111/j.1742-6723.2011.01410.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Deibener-Kaminsky J, Lesesve JF, Grosset S, Pruna L, Schmall-Laurain MC, Benetos A, Kaminsky P. [Clinical relevance of leukocyte differential in patients with marked leukocytosis in the emergency room]. Rev Med Interne 2011; 32:406-10. [PMID: 21292359 DOI: 10.1016/j.revmed.2010.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 11/25/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We analyzed the characteristics of the leukocyte differential and the clinical outcome in patients admitted in an emergency department with marked leukocytosis greater than 20×10(9)G/L. METHODS We studied a case series of consecutive patients admitted in an emergency department. The medical records were retrospectively reviewed after patient discharge. Three groups were defined: patients with infectious disorders (group I), noninfectious disorders (group II), and trauma (group III). Admission in intensive care unit (ICU), consciousness impairment or death defined the subgroup S of high severity. RESULTS Groups I, II and III comprised, respectively, 150, 95 and 86 patients. The group I presented with higher temperature and neutrophilia (22,2±4.9 vs 20.9±4.0 and 21.1±3.9×10(9)G/L; P<0.001), and more profound eosinopenia (0.058±0.094 versus 0.098±0.170 and 0.092±0.104×10(9)G/L; P<0.001) and lymphopenia (1.16±0.98 vs 1.53±1.04 and 1.73±1.10×10(9)G/L; P<0.001) than the two other groups. Both neutrophilia and lymphopenia were independent predictors of infection by multivariate analysis. Frequencies of admission in ICU were, respectively, 8.7%, 40% and 43% (P<0.001). Leukocyte and neutrophil counts were significantly higher and basophil count significantly lower in subgroup S. Overall, 13.6% of the patients died and were characterized by basopenia. CONCLUSION Marked leukocytosis indicated severe illness. Lymphopenia, eosinopenia and temperature were significant predictors of infection. A more severe clinical course was correlated with higher neutrophilia and basopenia.
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Affiliation(s)
- J Deibener-Kaminsky
- Service de gériatrie et médecine interne, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre cedex, France
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Abstract
Leukocytosis (raised concentration of white cells in the blood) is commonly associated with infection or inflammation, but can occur in a wide variety of other conditions. Leukocytosis has also been linked with increased mortality and morbidity in a number of studies. We have systematically reviewed the relevant literature, which clearly demonstrates an association between leukocytosis and mortality-particularly due to cardiovascular or cerebrovascular causes. The mechanisms of this effect are uncertain but, when combined with other markers predictive of death, leukocytosis may contribute to modelling systems to predict in-patient mortality risk.
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Affiliation(s)
- K Asadollahi
- Department of Epidemiology, Ilam University of Medical Sciences, Ilam, Iran.
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19
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Saghir F, Abboud E, Veres C, Feldman L. A myeloproliferative disorder associated with isochromosome 14q. Am J Med Sci 2002; 324:166-9. [PMID: 12240716 DOI: 10.1097/00000441-200209000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of isochromosome 14q-related myeloid cell disorder. To our knowledge, this report describes the first case of an unclassifiable chronic myeloproliferative disorder associated with this karyotypic abnormality.
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Affiliation(s)
- Faisal Saghir
- Department of Medicine, Finch University of Health Sciences/The Chicago Medical School at Sinai Hospital Medical Center, Illinois 60608, USA
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20
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Wanahita A, Goldsmith EA, Musher DM. Conditions associated with leukocytosis in a tertiary care hospital, with particular attention to the role of infection caused by clostridium difficile. Clin Infect Dis 2002; 34:1585-92. [PMID: 12032893 DOI: 10.1086/340536] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2001] [Revised: 01/30/2002] [Indexed: 12/22/2022] Open
Abstract
Few modern studies have enumerated the conditions associated with leukocytosis. Our clinical experience has implicated Clostridium difficile infection in a substantial proportion of patients with leukocytosis. In a prospective, observational study of 400 inpatients with WBC counts of >/=15,000 cells/mm(3), we documented >/=1 infection in 207 patients (53%). Of these 207 patients, 97 (47%) had pneumonia, 60 (29%) had urinary tract infection, 34 (16%) had soft-tissue infection, and 34 (16%) had C. difficile infection. C. difficile infection was present in 25% of patients with WBC counts of >30,000 cells/mm(3) who did not have hematological malignancy. Other causes of leukocytosis in the 400 patients included physiological stress, in 152 patients (38%); medications or drugs, in 42 (11%); hematological disease, in 22 (6%); and necrosis or inflammation, in 22 (6%). C. difficile infection is a prominent cause of leukocytosis and this diagnosis should be considered for patients with WBC counts of >/=15,000 cells/mm(3), even in the absence of diarrheal symptoms.
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Affiliation(s)
- Anna Wanahita
- Infectious Disease Section, Medical Service, Veterans Affairs Medical Center, Houston, TX, 77030, USA.
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21
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Lucroy MD, Madewell BR. Clinical outcome and diseases associated with extreme neutrophilic leukocytosis in cats: 104 cases (1991-1999). J Am Vet Med Assoc 2001; 218:736-9. [PMID: 11280408 DOI: 10.2460/javma.2001.218.736] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe diseases, prognosis, and clinical outcomes associated with extreme neutrophilic leukocytosis in cats. DESIGN Retrospective study. ANIMALS 104 cats with extreme neutrophilic leukocytosis. PROCEDURE Medical records from 1991 to 1999 were examined to identify cats that had > or =50,000 WBC/microl with > or =50% neutrophils. Signalment, absolute and differential WBC counts, rectal temperature, clinical or pathologic diagnosis, duration and cost of hospitalization, and survival time were reviewed. RESULTS Mean age of cats was 8.3 years, mean WBC count was 73,055 cells/microl, and mean absolute neutrophil count was 59,046 cells/microl. Mean duration of hospitalization was 5.9 days, and mean cost of hospitalization was $2,010. Twenty-nine (28%) cats were febrile, and 63 (61%) cats died. Overall median survival time was 30 days. Cats with neoplasia were nearly 14 times as likely to die unexpectedly as cats with other diseases. CONCLUSIONS AND CLINICAL RELEVANCE Extreme neutrophilic leukocytosis was associated with a high mortality rate. The prognostic importance of extreme neutrophilic leukocytosis should not be overlooked. Cats and dogs have similar diseases, mortality rates, and treatment costs associated with extreme neutrophilic leukocytosis.
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Affiliation(s)
- M D Lucroy
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis 95616, USA
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Raymond DP, Crabtree TD, Pelletier SJ, Gleason TG, Banas LE, Patel S, Pruett TL, Sawyer RG. Extremes of White Blood Cell Count do not Independently Predict Outcome among Surgical Patients with Infection. Am Surg 2000. [DOI: 10.1177/000313480006601207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Historically patients with severely depressed or elevated white blood cell (WBC) counts during infection were felt to have worse outcomes. To test this assumption we prospectively analyzed all infections on the surgical services at the University of Virginia hospital between December 1, 1996 and April 1, 1999. Among 1737 infectious episodes 59 presented with leukopenia (WBC count ≤ 3,000 cells/μL) whereas 66 presented with leukemoid responses (WBC count ≥ 30,000 cells/μL). Compared with other infected patients leukopenic patients had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (18 ± 0.9 vs 12 ± 0.2, P < 0.0001) and mortality (23.7% vs 11.4%, P = 0.004). Patients with leukemoid responses also had higher APACHE II scores (21 ± 1.0 vs 12 ± 0.2, P < 0.0001) and mortality (30.3% vs 11.4%, P < 0.0001). Compared with a control group randomly matched (2:1) by age and APACHE II score, however, there was no significant difference in mortality associated with leukopenia or a leukemoid response. Furthermore logistic regression did not reveal leukopenia or leukemoid responses to be independent predictors of mortality (odds ratio for death with leukopenia = 1.57, 95% confidence interval = 0.63–3.91, P = 0.33; odds ratio for death with leukemoid response = 1.19, 95% confidence interval = 0.70–2.02, P = 0.53). Although very low or very high WBC counts may represent markers of severe illness in infected surgical patients they do not appear to be significant contributors to a worsened outcome.
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Affiliation(s)
- Daniel P. Raymond
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Traves D. Crabtree
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Shawn J. Pelletier
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Thomas G. Gleason
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Lauren E. Banas
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Shefali Patel
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Timothy L. Pruett
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
| | - Robert G. Sawyer
- Surgical Infectious Disease Laboratory, University of Virginia Department of Surgery, Charlottesville, Virginia
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