Approach to the patient with neutrophilia
- Thomas D Coates, MD
Thomas D Coates, MD
- Professor of Pediatrics and Pathology
- University of Southern California School of Medicine
- Section Editors
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
- Peter Newburger, MD
Peter Newburger, MD
- Section Editor — White Blood Cell Disorders
- Ali and John Pierce Professor of Pediatric Hematology/Oncology
- University of Massachusetts Medical School
Neutrophilia refers to an increase of peripheral blood neutrophils at least two standard deviations above the mean. For adults, this generally corresponds to >7700 neutrophils/microL (typically seen in patients with >11,000 white blood cells/microL).
This topic will present the clinical evaluation of neutrophilia and its causes. Evaluation of patients with lymphocytosis and eosinophilia are discussed separately. (See "Causes of neutrophilia" and "Approach to the adult with lymphocytosis or lymphocytopenia" and "Approach to the patient with unexplained eosinophilia".)
The normal range (ie, two standard deviations above and below the mean) for the white blood cell (WBC) count in adults is 4400 to 11,000 cells/microL in most clinical laboratories. Approximately 60 to 70 percent of leukocytes in the peripheral blood are mature polymorphonuclear neutrophils (PMN) . Thus, the threshold for neutrophilia in most clinical laboratories is approximately 7700/microL (11,000 WBC/microL x 70 percent).
Normal values for WBC in children vary based on age (table 1).
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- CAUSES OF NEUTROPHILIA
- Normal variation
- Cigarette smoking
- Endocrine and other causes
- Myeloproliferative neoplasms
- - Chronic myeloid leukemia
- - Juvenile myelomonocytic leukemia
- - Other myeloproliferative neoplasms
- Nonhematologic malignancy
- Genetic/Inherited disorders
- - Leukocyte adhesion deficiency
- - Hereditary chronic neutrophilia
- - Down syndrome
- - Cryopyrin-associated periodic syndromes
- URGENCY OF EVALUATION
- CLINICAL EVALUATION
- History and physical examination
- Complete blood count (CBC)
- Peripheral blood smear
- - Neutrophil abnormalities
- - Spurious neutrophilia (artifacts)
- Platelet clumping
- - Neutrophilia combined with other hematologic abnormalities
- Other leukocyte abnormalities
- Red blood cells (RBCs)
- - Other laboratory tests
- Specialized testing
- LEUKEMOID REACTION/HYPERLEUKOCYTOSIS