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Neutrophilia or Granulocytosis  (a neutrophil count greater than 10,000/mm3) 

Serious bacterial infections and chronic inflammation are usually associated with changes include increased numbers of young cells (bands), of cells with residual endoplasmic reticulum (Dohle bodies), and of cells with more prominent primary granules (toxic granulation).

Evaluation of neutrophilia

When there is uncertainty, bone marrow aspiration and biopsy, chromosomal analysis, and marrow cultures for bacteria (e.g., Salmonella, Brucella, Mycobacteria, and fungi) are warranted. The results of these tests will enable the clinician to make a diagnosis of CML (or another myeloproliferative disorder), a granulomatous infection, inflammatory disease, or metastatic malignancy. If no such cause can be found in an otherwise healthy-appearing person, a diagnosis of idiopathic or familial neutrophilia may be considered and repeated neutrophil counts performed at monthly intervals until the diagnosis is clarified.

See  Neutropenia

Scientific American Medicine  October 1999



REF: 2010-04 Heme Dept

Leukocytosis  - Definition: WBC >11,000 per mm3 (11 X 109 per L)

Appropriate evaluation by primary care physician:

1. History:

2. Physical examination:

3. Laboratory investigation: Always do CBC with differential as first step to determine which category of leukocytosis is present

4. Neutrophilia:

5. Lymphocytosis:

6. Blasts: call Hematology. Leukemia, myelodysplastic syndromes, marrow infiltration, lymphoma may present with leukocytosis/blasts. Usually the CBC is completely abnormal (anemia, thrombocytopenia).

7. Eosinophilia: "worms, wheezes, weird diseases (rheumatic, etc.)"; persistent significant eosinophilia can be primary heme disorder; if no clinical evidence for these underlying entities, heme referral is appropriate.

When you should refer to Hematology?

When it is likely that hematology will have something to add to the evaluation and management of the patient. In other words, if you have a patient who has had leukocytosis for a few years and has no symptoms of serious hematologic disease, continued observation (by PCP) is appropriate. It is very unlikely that we will do anything more than take a good history and perform physical examination.

Other tests which can be useful:

" Leukocyte alkaline phosphatase: for evaluation of neutrophilia, particularly important if progressive and/or associated with left shift in neutrophil series (eg bands, metas, myelos, pros, and even blasts); if low, highly likely to be chronic myelogenous leukemia. If normal or elevated, clinical evaluation as above is enough.

" CXR for smoker with new leukocytosis, cough, weight loss, or any worrisome symptoms that might suggest malignancy.

Dr. Advice: if you are not certain whether patient needs additional investigation, we now have Dr. Advice available for "econsult":
Open telephone encounter
Enter Dr Advice in "reason for message"
Documentation: brief history/workup, and questions you have
Forward to Bellflower Oncology pool


Basophilia (basophil actual count > 150/mm3)
Basophilia is an uncommon cause of leukocytosis. Basophils are inflammatory mediators of substances such as histamine. These cells, along with similar tissue-based cells (mast cells), have receptors for IgE and participate in the degranulation of white blood cells that occurs during allergic reactions, including anaphylaxis.

Causes of basophilia, some of uncertain origin, are listed in Table below.

Etiology of Eosinophilia

Etiology of Lymphocytosis (Absolute count > 4,000/mm3)

* Lymphocytopenia is defined as total count < 1,000/mm3.

Primary lymphocytosis (Lymphoproliferative disorders)

Secondary lymphocytosis (Reactive lymphocytosis)