Leukemoid reaction: Difference between revisions

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==Background==
  
==Background==
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* Significant leukocytosis and neutrophilia in the absence of a hematologic malignancy
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*Significant leukocytosis and neutrophilia in the absence of a hematologic malignancy
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** e.g. WBC ≥30-50 with ≥50% granulocytes
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**e.g. WBC ≥30-50 with ≥50% granulocytes
   
 
==Differential Diagnosis==
  
==Differential Diagnosis==
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* '''Infections'''
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*'''Infections'''
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** [[Sepsis]], [[pneumonia]], [[urinary tract infection]]
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**[[Sepsis]], [[pneumonia]], [[urinary tract infection]]
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** ''[[Clostridioides difficile]]'' colitis (often quite high)
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**''[[Clostridioides difficile]]'' colitis (often quite high)
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** Disseminated [[tuberculosis]]
  
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** Severe [[shigellosis]]
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**Disseminated [[tuberculosis]]
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**Severe [[shigellosis]]
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** Postpartum ''[[Clostridium sordellii]]''
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**Postpartum ''[[Clostridium sordellii]]''
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* '''Inflammation'''
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*'''Inflammation'''
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** [[Pancreatitis]]
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**[[Pancreatitis]]
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** Mesenteric inflammatory pseudotumor
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**Mesenteric inflammatory pseudotumor
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* '''Malignancies'''
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*'''Malignancies'''
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** Carcinomas (lung, oropharyngeal, gastrointestinal, genitourinary)
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**Carcinomas (lung, oropharyngeal, gastrointestinal, genitourinary)
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** Hodgkin lymphoma
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**[[Hodgkin lymphoma]]
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** Melanoma
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**[[Melanoma]]
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** Sarcoma
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**[[Sarcoma]]
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* '''Drugs'''
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*'''Drugs'''
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** Corticosteroids
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**[[Corticosteroids]]
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** Minocycline
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**[[Minocycline]]
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** Recombinant hematopoietic growth factors
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**Recombinant hematopoietic growth factors
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* '''Miscellaneous'''
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*'''Miscellaneous'''
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** [[Splenectomy]]
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**[[Splenectomy]]
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** Ethylene glycol intoxication
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**[[Ethylene glycol intoxication]]
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** Severe hemorrhage or acute hemolysis
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**Severe hemorrhage or acute [[hemolysis]]
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** Alcoholic steatohepatitis
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**[[Alcoholic steatohepatitis]]
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{| class="wikitable"
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|+From [[CiteRef::sakka2006an]]
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!Characteristic
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!Leukemoid reaction
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![[Chronic myeloid leukemia]]
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![[Chronic neutrophilic leukemia]]
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|-
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|[[Peripheral blood film]]
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|Mature neutrophils with a left shift
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|Immature cells, basophils, and eosinophils
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|Marked neutrophilia without immagure cells
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|-
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|[[LAP score]]
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|high
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|low
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|high
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|-
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|Vitamin B12
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|variable or high
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|high
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|high
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|-
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|Bone marrow
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|myeloid hyperplasia, orderly maturation, normal morphology
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|basophilia, eosinophilia, monocytosis, slight increase in blasts and reticulin fibrosis
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|myeloid hyperplasia, orderly maturation, normal morphology, but with packed bone marrow, slight increase in reticulin
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|-
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|Cytogeneic analysis
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|normal
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|BCR/ABL translocation
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|present in 35%
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|-
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|Serum G-CSF
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|high
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|low
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|low
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|-
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|Clonality studies
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|polyclonal
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|monoclonal
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|monoclonal
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|}
   
 
==Further Reading==
  
==Further Reading==
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* 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]

Latest revision as of 11:03, 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

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

Further Reading

  • Leukemoid reaction: Spectrum and prognosis of 173 adult patients. Clin Infect Dis. 2013;57:e177. doi: 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: 10.1016/j.ejim.2006.04.004

References

  1. ^  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.

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