Leukemoid reaction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Jogeet Singh Sekhon, M.D. [3]

Overview

Leukemoid reaction is a reversible increase in production of white blood cells in response to a stimulus, with white blood cell count of more than 25,000-30,000 per mm3 . Leukocytosis is increase in white blood cell count of more than 10,000 per mm3 and when the count exceeds 25,000 per mm3, with more than 2% immature white blood cells but absence of any blast cells, differentiating it from leukemias. Leukemoid reaction is classified according to the type of hematopoietic lineage of the bone marrow. Leukemoid reactions are mostly triggered by bacterial or viral infections. Leukemoid reaction is differentiated from leukemias by the absence of blast cells on peripheral blood film and high LAP score. Leukemoid reaction can lead to serious complications such as tumor lysis syndrome and DIC. The treatment includes treating the underlying cause and leukapheresis.

Historical Perspective

  • Leukemoid reaction was discovered in 1926 by Krumbharr.

Classification

Leukemoid reaction can be classified according to the type of hematopoietic lineage of the bone marrow[1].

Pathophysiology

Hematopoietic growth factors in leukocytosis, By Hematopoietic_growth_factors.svg: Rod Flower; Humphrey P. Rang; Maureen M. Dale; Ritter, James M. (2007) Rang & Dale's pharmacology, Churchill Livingstone ISBN: 0-443-06911-5.User:Mikael Häggström and A. Radderivative work: Furfur - This file was derived from: Hematopoietic growth factors.svg:, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=31083166


Causes

Differentiating Leukemoid reaction from Other Diseases

Leukemoid reaction is differentiated from leukemia by following ways[11][12]:

Differential diagnosis of leukemia vs leukemoid reaction
Differentiating features Leukemia Leukemoid reaction
Causes Carcinogens Infectious agents, biologically active substances and

products of tissue destruction

Pathogenesis The transformation of normal haematopoietic

cells to a tumor

Activation of normal hematopoiesis and exit of immature leukocytes

into the bloodstream

Duration Chronic Temporary and reversible
Genetic level Defect No defect
Splenomegaly Present Not present
Peripheral blood Immature cells, pancytopenia Mature and immature granulocytes with left shift
Bone marrow Increase in blasts and immature cells Myeloid hyperplasia and normal morphology
LAP score Low High
Toxic granules (suggestive of infection) Absent Present
Dohle inclusion bodies Absent Present

Leukemoid reaction should be differentiated from other causes of leucocytosis. The below table discusses different causes of leucocytosis:

Category Condition Etiology Mechanism Congenital Acquried Clinical manifestations Para−clinical findings Gold standard Associated findings
Demography History Symptoms Signs
Lab Findings
Physiologic Increased bone marrow production Demargination of peripheral blood neutrophils Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other CBC PBS Bone marrow exam ESR/CRP BUN/Cr LFT
Autonomous Reactive WBC HB Plt
Hematologic Hereditary neutrophilia[13] + + Rare autosomal dominant genetic disorder
  • Positive family history
Normal Nl + Nl Nl Nl Nl Nl Nl Molecular testing
Myeloproliferative neoplasms[14] + + + Elderly Exposure to ± + Nl + ↑/↓ ↑/↓ Nl Nl Bone marrow examination + clinical manifestation
Polycythemia vera[15] + + Mean age >60 years old + + Nl to ↑
  • Elevated normochromic, normocytic RBCs
  • Thrombocytosis
  • ≥ 10% immature myeloid precursors
  • Leukoerythroblastic picture
Nl Nl Nl Bone marrow examination + clinical manifestation
Microangiopathic hemolytic anemia (MAHA)[16] + + + Any + + + NA Bone marrow examination + clinical manifestation
Leukoerythroblastosis[17] + + Any + Nl + Nl Bone marrow biopsy
Immunology/

Rheumatology

Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Leukocyte adhesion deficiency[18] + + Rare autosomal recessive, LAD II more in Middle East and Brazil
  • Positive family history
+ Nl ↓/↑
  • Leukocytosis
  • Leukocytosis
Nl Nl Nl Flow cytometry
Cryopyrin-associated periodic syndromes[19] + + Autosomal dominant autoinflammatory syndrome
  • Positive family history
+ Nl + ↓/↑
  • Leukocytosis
  • Leukocytosis
Nl Genetic tests
Rheumatoid arthritis[20][21] + + Any, more in young women, between 30-60 years old + Nl +
  • Leukocytosis
NA Nl Nl Clinical manifestation + positive anti-CCP antibodies
Juvenile onset rheumatoid arthritis[22] + + Children under the age of 16
  • Positive family history
  • Blotchy rash on a child's arms and legs
+ Nl + +
  • Leukocytosis
NA Nl Nl Clinical manifestation + laboratory findings
Adult Still's disease[23] + + Rare autoimmune disease NA + Nl + +
  • Leukocytosis
NA Nl Nl Diagnosis of exclusion
Kawasaki disease[24] + + Autoimmune disease, more in Asian ethnicity boys NA + + Nl + +
  • Leukocytosis
NA Nl Nl Diagnostic criteria
IBD[25] + + Autoimmune disease, more in young
  • Stress
  • Positive family history
+ + Nl + + +
  • Leukocytosis
NA Nl Nl Colonoscopy and biopsy
Sarcoidosis[26] + + Autoimmune disease, more in young African American women
  • Positive family history
+ + Nl + +

Bilateral hilar adenopathy

+
  • Leukocytosis
NA Nl Nl Diagnosis of exclusion
Chronic hepatitis[27] + + Elderly + + + + +
  • Leukocytosis
NA Liver biopsy
Sweet syndrome[28] + + Rare + + Nl + +
  • Leukocytosis
Nl Nl Diagnostic criteria
Acute gout[29] + + Older males + +
  • Leukocytosis
NA Nl Clinical manifestation
Medication Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Steroid[30] + + + Any + Nl to ↓ Nl to ↓ Nl Clinical manifestation + history of drug consumption
Filgrastim (Myeloid growth factor)[31] + + + Any + Nl to ↓ + Nl to ↓ NA NA Nl Nl Clinical manifestation + history of drug consumption
Lithium[32]
  • Unknown
+ + + Any Nl Nl to ↓ NA NA Nl Nl Clinical manifestation + history of drug consumption
Catecholamines

(epinephrine)[33]

  • Stimulation of bone marrow myelopoiesis
  • Egress into the circulation
+ + + Any Nl to ↓ Nl Nl Clinical manifestation + history of drug consumption
ATRA[34] + + + Any Nl Nl Nl NA NA Nl Clinical manifestation + history of drug consumption
Other Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings
Infections[35] + + + + Any
  • Acutely ill
+ + Nl to ↓ ± ± ± Nl Nl Clinical manifestation+ culture
  • Depends on etiology
Allergy[36]
  • Unknown
  • Activation of chloride transport
+ + + + Any Nl to ↓ Nl Nl Clinical manifestation
Post splenectomy[37]
  • Unknown
+ + + Any
  • Normal
± Nl + Nl Nl Clinical manifestation
Cigarette smoking[38] + + + Any Nl NA NA Nl Nl Nl Clinical manifestation
Stress/exercise[39]
  • Reduced plasma volume
+ + + Athlete
  • Normal
Nl Nl Nl Clinical manifestation
Infancy[40] Physiologic + + Infancy
  • Normal
Nl NA NA Nl Nl Nl Clinical manifestation
Pregnancy[41] Physiologic + + Pregnancy
  • Normal
Nl NA NA Nl Nl Nl Clinical manifestation
Platelet clumping[42] Spurious + Any
  • Normal
Nl Nl Nl Nl Nl Nl Clinical manifestation
Mixed cryoglobulinemia[43] Spurious + Any Nl + Nl to ↓ Nl Nl Nl Nl Skin biopsy
Category Condition Etiology Physiologic Autonomous increased bone marrow production Reactive increased bone marrow production Demargination of peripheral blood neutrophils Congenital Acquried Demography History Appearance Fever Abdominal pain BP Asplenia Hepatosplenomegaly Lymphadenopathy Joint involvement Other signs WBC HB Plt PBS Bone marrow exam ESR/CRP BUN/Cr LFT Gold standard Associated findings

Epidemiology and Demographics

Age

  • Patients of all age groups may develop leukemoid reaction[1][44].
  • Normal white blood cell count changes with age.
  • Leukemoid reaction in neonates is more common, compared to children and adults.

Gender

  • Leukemoid reaction affects men and women equally.

Race

  • There is no racial predilection for the development of leukemoid reaction.

Risk Factors

Screening

No screening is done for leukemoid reaction.

Natural History, Complications, and Prognosis

History

The majority of patients with leukemoid reaction have the following complaints[45][46]

Complications

Prognosis

  • Prognosis generally depends on the underlying etiologies.
  • If the white blood cell count reaches more than 50,000 per mm3, life threatening complications can occur.

Diagnosis

Symptoms

  • Obtain history of the following:

Laboratory findings

Electrocardiogram

No specific ECG changes in leukemoid reaction.

X-Ray

No specific x ray changes in leukemoid reaction.

Echocardiography and Ultrasound

No echocardiography and ultrasound findings.

CT

No CT scan findings in leukemoid reaction.

MRI

No specific MRI findings in leukemoid reaction.

Treatment

Medical Therapy

Surgery

The treatment depends on the underlying cause. In general, there is no role for surgery.

Primary prevention

Prevention and treatment of infections.

Secondary prevention

Treatment of underlying cause and reduction of white blood cell count.

See also

References

  1. 1.0 1.1 1.2 1.3 Abramson N, Melton B (2000). "Leukocytosis: basics of clinical assessment". Am Fam Physician. 62 (9): 2053–60. PMID 11087187.
  2. Ward HN, Reinhard EH (1971). "Chronic idiopathic leukocytosis". Ann Intern Med. 75 (2): 193–8. PMID 5558646.
  3. Leukocytosis. Wikipedia. https://en.wikipedia.org/wiki/Leukocytosis Accessed on May 23, 2016
  4. Wanahita A, Goldsmith EA, Musher DM (2002). "Conditions associated with leukocytosis in a tertiary care hospital, with particular attention to the role of infection caused by clostridium difficile". Clin Infect Dis. 34 (12): 1585–92. doi:10.1086/340536. PMID 12032893.
  5. Lawrence YR, Raveh D, Rudensky B, Munter G (2007). "Extreme leukocytosis in the emergency department". QJM. 100 (4): 217–23. doi:10.1093/qjmed/hcm006. PMID 17314214.
  6. McBride JA, Dacie JV, Shapley R (1968). "The effect of splenectomy on the leucocyte count". Br J Haematol. 14 (2): 225–31. PMID 5635603.
  7. Spencer RP, McPhedran P, Finch SC, Morgan WS (1972). "Persistent neutrophilic leukocytosis associated with idiopathic functional asplenia". J Nucl Med. 13 (3): 224–6. PMID 5058244.
  8. Foster NK, Martyn JB, Rangno RE, Hogg JC, Pardy RL (1986). "Leukocytosis of exercise: role of cardiac output and catecholamines". J Appl Physiol (1985). 61 (6): 2218–23. doi:10.1152/jappl.1986.61.6.2218. PMID 3804928.
  9. Brodeur GM, Dahl GV, Williams DL, Tipton RE, Kalwinsky DK (1980). "Transient leukemoid reaction and trisomy 21 mosaicism in a phenotypically normal newborn". Blood. 55 (4): 691–3. PMID 6444534.
  10. Harvey Y, Bleakley S, Blombery P, Bain BJ (2018). "Marked leukemoid reaction in a patient with metastatic breast carcinoma". Am J Hematol. 93 (2): 306–307. doi:10.1002/ajh.24849. PMID 28699170.
  11. Sakka V, Tsiodras S, Giamarellos-Bourboulis EJ, Giamarellou H (2006). "An update on the etiology and diagnostic evaluation of a leukemoid reaction". Eur J Intern Med. 17 (6): 394–8. doi:10.1016/j.ejim.2006.04.004. PMID 16962944.
  12. Updyke KM, Morales-Lappot J, Lee T (2017). "Atypical Presentation of Chronic Myelogenous Leukemia". Cureus. 9 (5): e1280. doi:10.7759/cureus.1280. PMC 5484601. PMID 28656128.
  13. Herring, William Benjamin; Smith, Laurin Gresham; Walker, Richard Isley; Herion, John Carroll (1974). "Hereditary neutrophilia". The American Journal of Medicine. 56 (5): 729–734. doi:10.1016/0002-9343(74)90642-1. ISSN 0002-9343.
  14. Tefferi A (February 2010). "Leukocytosis as a risk factor for thrombosis in myeloproliferative neoplasms-biologically plausible but clinically uncertain". Am. J. Hematol. 85 (2): 93–4. doi:10.1002/ajh.21614. PMID 20052751.
  15. Boiocchi L, Gianelli U, Iurlo A, Fend F, Bonzheim I, Cattaneo D, Knowles DM, Orazi A (November 2015). "Neutrophilic leukocytosis in advanced stage polycythemia vera: hematopathologic features and prognostic implications". Mod. Pathol. 28 (11): 1448–57. doi:10.1038/modpathol.2015.100. PMID 26336886.
  16. Morton JM, George JN (June 2016). "Microangiopathic Hemolytic Anemia and Thrombocytopenia in Patients With Cancer". J Oncol Pract. 12 (6): 523–30. doi:10.1200/JOP.2016.012096. PMID 27288467.
  17. Canbolat Ayhan A, Timur C, Ayhan Y, Kes G (June 2014). "Leukoerythroblastosis Mimicking Leukemia: A case report". Iran J Pediatr. 24 (3): 332–3. PMC 4276592. PMID 25562031.
  18. Levy-Mendelovich S, Rechavi E, Abuzaitoun O, Vernitsky H, Simon AJ, Lev A, Somech R (April 2016). "Highlighting the problematic reliance on CD18 for diagnosing leukocyte adhesion deficiency type 1". Immunol. Res. 64 (2): 476–82. doi:10.1007/s12026-015-8706-5. PMID 26434744.
  19. Labrousse M, Kevorkian-Verguet C, Boursier G, Rowczenio D, Maurier F, Lazaro E, Aggarwal M, Lemelle I, Mura T, Belot A, Touitou I, Sarrabay G (September 2018). "Mosaicism in autoinflammatory diseases: Cryopyrin-associated periodic syndromes (CAPS) and beyond. A systematic review". Crit Rev Clin Lab Sci. 55 (6): 432–442. doi:10.1080/10408363.2018.1488805. PMID 30035647.
  20. Scott DL, Wolfe F, Huizinga TW (September 2010). "Rheumatoid arthritis". Lancet. 376 (9746): 1094–108. doi:10.1016/S0140-6736(10)60826-4. PMID 20870100.
  21. Glant TT, Mikecz K, Rauch TA (February 2014). "Epigenetics in the pathogenesis of rheumatoid arthritis". BMC Med. 12: 35. doi:10.1186/1741-7015-12-35. PMC 3936819. PMID 24568138.
  22. Naz S, Mushtaq A, Rehman S, Bari A, Maqsud A, Khan MZ, Ahmad TM (June 2013). "Juvenile rheumatoid arthritis". J Coll Physicians Surg Pak. 23 (6): 409–12. doi:06.2013/JCPSP.409412 Check |doi= value (help). PMID 23763801.
  23. Kadavath S, Efthimiou P (February 2015). "Adult-onset Still's disease-pathogenesis, clinical manifestations, and new treatment options". Ann. Med. 47 (1): 6–14. doi:10.3109/07853890.2014.971052. PMID 25613167.
  24. Sundel RP (2015). "Kawasaki disease". Rheum. Dis. Clin. North Am. 41 (1): 63–73, viii. doi:10.1016/j.rdc.2014.09.010. PMID 25399940.
  25. Zhang YZ, Li YY (January 2014). "Inflammatory bowel disease: pathogenesis". World J. Gastroenterol. 20 (1): 91–9. doi:10.3748/wjg.v20.i1.91. PMC 3886036. PMID 24415861.
  26. Modaresi Esfeh J, Culver D, Plesec T, John B (March 2015). "Clinical presentation and protocol for management of hepatic sarcoidosis". Expert Rev Gastroenterol Hepatol. 9 (3): 349–58. doi:10.1586/17474124.2015.958468. PMID 25473783.
  27. Gish RG, Given BD, Lai CL, Locarnini SA, Lau JY, Lewis DL, Schluep T (September 2015). "Chronic hepatitis B: Virology, natural history, current management and a glimpse at future opportunities". Antiviral Res. 121: 47–58. doi:10.1016/j.antiviral.2015.06.008. PMID 26092643.
  28. Das A, Burmeister R, Chhaya R, Eisenga B, Kumar A (September 2018). "Sweet Syndrome in a Patient With Systemic Lupus Erythematosus". J Clin Rheumatol. doi:10.1097/RHU.0000000000000904. PMID 30247226.
  29. Dalbeth N, Zhong CS, Grainger R, Khanna D, Khanna PP, Singh JA, McQueen FM, Taylor WJ (March 2014). "Outcome measures in acute gout: a systematic literature review". J. Rheumatol. 41 (3): 558–68. doi:10.3899/jrheum.131244. PMC 4217650. PMID 24334652.
  30. Shoenfeld Y, Gurewich Y, Gallant LA, Pinkhas J (November 1981). "Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis". Am. J. Med. 71 (5): 773–8. PMID 7304648.
  31. Crawford J, Armitage J, Balducci L, Becker PS, Blayney DW, Cataland SR, Heaney ML, Hudock S, Kloth DD, Kuter DJ, Lyman GH, McMahon B, Rugo HS, Saad AA, Schwartzberg LS, Shayani S, Steensma DP, Talbott M, Vadhan-Raj S, Westervelt P, Westmoreland M, Dwyer M, Ho M (October 2013). "Myeloid growth factors". J Natl Compr Canc Netw. 11 (10): 1266–90. PMID 24142827.
  32. Aiff H, Attman PO, Aurell M, Bendz H, Ramsauer B, Schön S, Svedlund J (May 2015). "Effects of 10 to 30 years of lithium treatment on kidney function". J. Psychopharmacol. (Oxford). 29 (5): 608–14. doi:10.1177/0269881115573808. PMID 25735990.
  33. Bedoui S, Lechner S, Gebhardt T, Nave H, Beck-Sickinger AG, Straub RH, Pabst R, von Hörsten S (November 2002). "NPY modulates epinephrine-induced leukocytosis via Y-1 and Y-5 receptor activation in vivo: sympathetic co-transmission during leukocyte mobilization". J. Neuroimmunol. 132 (1–2): 25–33. PMID 12417430.
  34. Bi KH, Jiang GS (December 2006). "Relationship between cytokines and leukocytosis in patients with APL induced by all-trans retinoic acid or arsenic trioxide". Cell. Mol. Immunol. 3 (6): 421–7. PMID 17257495.
  35. Horasan ES, Dağ A, Ersoz G, Kaya A (October 2013). "Surgical site infections and mortality in elderly patients". Med Mal Infect. 43 (10): 417–22. doi:10.1016/j.medmal.2013.07.009. PMID 24012414.
  36. Davis M, van der Hilst J (2018). "Mimickers of Urticaria: Urticarial Vasculitis and Autoinflammatory Diseases". J Allergy Clin Immunol Pract. 6 (4): 1162–1170. doi:10.1016/j.jaip.2018.05.006. PMID 29871797. Vancouver style error: initials (help)
  37. Bilello JF, Sharp VL, Dirks RC, Kaups KL, Davis JW (2018). "After the embo: predicting non-hemorrhagic indications for splenectomy after angioembolization in patients with blunt trauma". Trauma Surg Acute Care Open. 3 (1): e000159. doi:10.1136/tsaco-2017-000159. PMC 5887792. PMID 29766137.
  38. Lymperaki E, Makedou K, Iliadis S, Vagdatli E (2015). "Effects of acute cigarette smoking on total blood count and markers of oxidative stress in active and passive smokers". Hippokratia. 19 (4): 293–7. PMC 5033137. PMID 27688691.
  39. Simpson RJ, Kunz H, Agha N, Graff R (2015). "Exercise and the Regulation of Immune Functions". Prog Mol Biol Transl Sci. 135: 355–80. doi:10.1016/bs.pmbts.2015.08.001. PMID 26477922.
  40. Nouatin O, Gbédandé K, Ibitokou S, Vianou B, Houngbegnon P, Ezinmegnon S, Borgella S, Akplogan C, Cottrell G, Varani S, Massougbodji A, Moutairou K, Troye-Blomberg M, Deloron P, Luty AJ, Fievet N (2015). "Infants' Peripheral Blood Lymphocyte Composition Reflects Both Maternal and Post-Natal Infection with Plasmodium falciparum". PLoS ONE. 10 (11): e0139606. doi:10.1371/journal.pone.0139606. PMC 4651557. PMID 26580401.
  41. Perseghin P (December 2015). "Erythrocyte exchange and leukapheresis in pregnancy". Transfus. Apher. Sci. 53 (3): 279–82. doi:10.1016/j.transci.2015.11.007. PMID 26621538.
  42. Castrillo A, Álvarez I, Tolksdorf F (April 2015). "In vitro evaluation of platelet concentrates suspended in additive solution and treated for pathogen reduction: effects of clumping formation". Blood Transfus. 13 (2): 281–6. doi:10.2450/2014.0162-14. PMC 4385077. PMID 25369589.
  43. Cacoub P, Comarmond C, Domont F, Savey L, Saadoun D (September 2015). "Cryoglobulinemia Vasculitis". Am. J. Med. 128 (9): 950–5. doi:10.1016/j.amjmed.2015.02.017. PMID 25837517.
  44. Hoofien A, Yarden-Bilavski H, Ashkenazi S, Chodick G, Livni G (2018). "Leukemoid reaction in the pediatric population: etiologies, outcome, and implications". Eur J Pediatr. 177 (7): 1029–1036. doi:10.1007/s00431-018-3155-5. PMID 29696475.
  45. 45.0 45.1 45.2 Ellison TA, Mandal K (2018). "Leukemoid reaction: Case report". J Thorac Cardiovasc Surg. 155 (4): e117–e118. doi:10.1016/j.jtcvs.2017.08.125. PMID 29366572.
  46. Wang Z, Cai Q, Li G, Jiang N, Niu Y (2017). "Giant Pheochromocytoma With Leukemoid Reaction: A Case Report". Urology. 99: e17–e19. doi:10.1016/j.urology.2016.08.021. PMID 27720771.
  47. Agrawal D, Kurwale N, Sharma BS (2016). "Leukocytosis after routine cranial surgery: A potential marker for brain damage in intracranial surgery". Asian J Neurosurg. 11 (2): 109–13. doi:10.4103/1793-5482.145066. PMC 4802930. PMID 27057215.



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