Leukemoid reaction: Difference between revisions
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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
| 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
- ^ 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.
