Hyperleukocytosis Complicated by Intracerebral Hemorrhage and Spurious Hypoxemia: A Case Report and Literature Review

Leukocytosis interference in clinical chemistry: Shall we still interpret test results without hematological data?

Background

Extreme leukocytosis is known to induce remarkable variations of some clinical chemistry tests, thus leading to possible clinical misinterpretation. This study aimed to define whether also moderate leukocytosis may influence the stability of glucose and blood gases.

Methods

Blood samples are sent to the local laboratory through a pneumatic tube system. Clinical chemistry testing is routinely performed using Lithium-heparin tubes (for glucose) and heparin blood gases syringes (for blood gas analysis). Stability of glucose (in uncentrifuged blood tubes) and blood gases (in syringes) was hence evaluated in samples maintained at room temperature. Results were also analyzed in 2 subgroups of samples with different leukocyte counts, i.e., those with leukocytes <15 × 10⁹/L and those with leukocytes >15 × 10⁹/L.

Results

An accelerated decrease of pH was observed in blood gases syringes with leukocytosis (i.e., >15 × 10⁹/L), while no difference was noted for other blood gases parameters (PCO2, PO2). Spurious and time-dependent hypoglycemia was noted in uncentrifuged blood tubes of patients with leukocytosis.

Conclusions

The results of our study suggest that even modest leukocytosis (i.e., around 15 × 10⁹/L), which is frequently encountered in clinical and laboratory practice, may be associated with significant variations of both glucose and pH. This would lead us to conclude that results of these parameters shall be accompanied by those of hematologic testing to prevent clinical misinterpretation, namely with leukocyte counts.