Leukemoid reaction: Difference between revisions

Latest revision as of 15:03, 19 September 2024

Background

Significant leukocytosis and neutrophilia in the absence of a hematologic malignancy
- e.g. WBC ≥30-50 with ≥50% granulocytes

Differential Diagnosis

Infections
- Sepsis, pneumonia, urinary tract infection
- Clostridioides difficile colitis (often quite high)
- Disseminated tuberculosis
- Severe shigellosis
- Postpartum Clostridium sordellii
Inflammation
- Pancreatitis
- Mesenteric inflammatory pseudotumor
Malignancies
- Carcinomas (lung, oropharyngeal, gastrointestinal, genitourinary)
- Hodgkin lymphoma
- Melanoma
- Sarcoma
Drugs
- Corticosteroids
- Minocycline
- Recombinant hematopoietic growth factors
Miscellaneous
- Splenectomy
- Ethylene glycol intoxication
- Severe hemorrhage or acute hemolysis
- Alcoholic steatohepatitis

From 1
Characteristic	Leukemoid reaction	Chronic myeloid leukemia	Chronic neutrophilic leukemia
Peripheral blood film	Mature neutrophils with a left shift	Immature cells, basophils, and eosinophils	Marked neutrophilia without immagure cells
LAP score	high	low	high
Vitamin B12	variable or high	high	high
Bone marrow	myeloid hyperplasia, orderly maturation, normal morphology	basophilia, eosinophilia, monocytosis, slight increase in blasts and reticulin fibrosis	myeloid hyperplasia, orderly maturation, normal morphology, but with packed bone marrow, slight increase in reticulin
Cytogeneic analysis	normal	BCR/ABL translocation	present in 35%
Serum G-CSF	high	low	low
Clonality studies	polyclonal	monoclonal	monoclonal

References

^ Vissaria Sakka, Sotirios Tsiodras, Evangelos J. Giamarellos-Bourboulis, Helen Giamarellou. An update on the etiology and diagnostic evaluation of a leukemoid reaction. European Journal of Internal Medicine. 2006;17(6):394-398. doi:10.1016/j.ejim.2006.04.004.

@@ Line 1: / Line 1: @@
 ==Background==
-* Significant leukocytosis and neutrophilia in the absence of a hematologic malignancy
+*Significant leukocytosis and neutrophilia in the absence of a hematologic malignancy
-** e.g. WBC ≥30-50 with ≥50% granulocytes
+**e.g. WBC ≥30-50 with ≥50% granulocytes
 ==Differential Diagnosis==
-* '''Infections'''
+*'''Infections'''
-** [[Sepsis]], [[pneumonia]], [[urinary tract infection]]
+**[[Sepsis]], [[pneumonia]], [[urinary tract infection]]
-** ''[[Clostridioides difficile]]'' colitis (often quite high)
+**''[[Clostridioides difficile]]'' colitis (often quite high)
-** Disseminated [[tuberculosis]]
-** Severe [[shigellosis]]
+**Disseminated [[tuberculosis]]
+**Severe [[shigellosis]]
-** Postpartum ''[[Clostridium sordellii]]''
+**Postpartum ''[[Clostridium sordellii]]''
-* '''Inflammation'''
+*'''Inflammation'''
-** [[Pancreatitis]]
+**[[Pancreatitis]]
-** Mesenteric inflammatory pseudotumor
+**Mesenteric inflammatory pseudotumor
-* '''Malignancies'''
+*'''Malignancies'''
-** Carcinomas (lung, oropharyngeal, gastrointestinal, genitourinary)
+**Carcinomas (lung, oropharyngeal, gastrointestinal, genitourinary)
-** Hodgkin lymphoma
+**[[Hodgkin lymphoma]]
-** Melanoma
+**[[Melanoma]]
-** Sarcoma
+**[[Sarcoma]]
-* '''Drugs'''
+*'''Drugs'''
-** Corticosteroids
+**[[Corticosteroids]]
-** Minocycline
+**[[Minocycline]]
-** Recombinant hematopoietic growth factors
+**Recombinant hematopoietic growth factors
-* '''Miscellaneous'''
+*'''Miscellaneous'''
-** [[Splenectomy]]
+**[[Splenectomy]]
-** Ethylene glycol intoxication
+**[[Ethylene glycol intoxication]]
-** Severe hemorrhage or acute hemolysis
+**Severe hemorrhage or acute [[hemolysis]]
-** Alcoholic steatohepatitis
+**[[Alcoholic steatohepatitis]]
+{| class="wikitable"
+|+From [[CiteRef::sakka2006an]]
+!Characteristic
+!Leukemoid reaction
+![[Chronic myeloid leukemia]]
+![[Chronic neutrophilic leukemia]]
+|-
+|[[Peripheral blood film]]
+|Mature neutrophils with a left shift
+|Immature cells, basophils, and eosinophils
+|Marked neutrophilia without immagure cells
+|-
+|[[LAP score]]
+|high
+|low
+|high
+|-
+|Vitamin B12
+|variable or high
+|high
+|high
+|-
+|Bone marrow
+|myeloid hyperplasia, orderly maturation, normal morphology
+|basophilia, eosinophilia, monocytosis, slight increase in blasts and reticulin fibrosis
+|myeloid hyperplasia, orderly maturation, normal morphology, but with packed bone marrow, slight increase in reticulin
+|-
+|Cytogeneic analysis
+|normal
+|BCR/ABL translocation
+|present in 35%
+|-
+|Serum G-CSF
+|high
+|low
+|low
+|-
+|Clonality studies
+|polyclonal
+|monoclonal
+|monoclonal
+|}
 ==Further Reading==
-* Leukemoid reaction: Spectrum and prognosis of 173 adult patients. ''Clin Infect Dis''. 2013;57:e177. doi: [https://doi.org/10.1093/cid/cit562 10.1093/cid/cit562]
-* An update on the etiology and diagnostic evaluation of a leukemoid reaction. ''Eur J Internal Med''. 2006 Oct;17(6):394-8. doi: [https://doi.org/10.1016/j.ejim.2006.04.004 10.1016/j.ejim.2006.04.004]
+*Leukemoid reaction: Spectrum and prognosis of 173 adult patients. ''Clin Infect Dis''. 2013;57:e177. doi: [https://doi.org/10.1093/cid/cit562 10.1093/cid/cit562]
+*An update on the etiology and diagnostic evaluation of a leukemoid reaction. ''Eur J Internal Med''. 2006 Oct;17(6):394-8. doi: [https://doi.org/10.1016/j.ejim.2006.04.004 10.1016/j.ejim.2006.04.004]