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 Cell Disorders
- Ali and John Pierce Professor of Pediatric Hematology/Oncology
- University of Massachusetts Medical School
The normal total white blood cell (WBC) count in adults varies from 4400 to 11,000 cells/microL (4.4 to 11.0 x 109/L), the majority of which (approximately 60 percent) are mature neutrophils. Leukocytosis is defined as a total WBC more than two standard deviations above the mean, or a value of greater than 11,000/microL in adults. By convention, leukocytosis to values in excess of 50,000 cells/microL, when due to causes other than leukemia, is termed a leukemoid reaction or hyperleukocytosis.
While leukocytosis is most commonly due to an increase in the absolute number of mature neutrophils (neutrophilia), it can also reflect a marked increase in the absolute numbers of lymphocytes, eosinophils, monocytes, or, more rarely, basophils. Granulocytosis is generally used interchangeably with neutrophilia, although the two terms are somewhat different, since granulocytosis can also reflect leukocytosis due to increased numbers of eosinophils or basophils.
The absolute neutrophil count (ANC) is equal to the product of the white blood cell count (WBC) and the percentage of polymorphonuclear cells (PMNs) and band forms noted on the WBC differential, and is calculated as follows:
ANC (cells/microL) = WBC (cells/microL) x percent (PMNs + bands) ÷ 100
An ANC above 7700/microL in patient with a total WBC less than 11,000/microL is called neutrophilia. An example of a setting in which this might occur is the patient with AIDS in whom an increase in neutrophils may be offset by the presence of significant lymphopenia. However, for the purposes of this discussion, neutrophilia will be synonymous with neutrophilic leukocytosis.
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- - Left shift
- - Leukemoid reaction
- Neutrophilic leukocytosis
- Lymphocytic leukocytosis
- Monocytic leukocytosis
- Eosinophilic and basophilic leukocytosis
- INITIAL APPROACH
- The history
- - Medications
- The physical examination
- INITIAL LABORATORY TESTING
- Normal variation
- Spurious leukocytosis
- - Platelet clumping
- - Cryoglobulinemia
- EVALUATION OF THE COMPLETE BLOOD COUNT
- Detection of infection or inflammation
- Complete blood counts in family members
- Combined abnormalities on the complete blood count
- - Anemia
- - Increased hematocrit
- - Increased platelet count
- - Decreased platelet count
- - Left shift in the WBC differential
- - Nucleated RBC and leukoerythroblastic picture
- - Monocytosis
- Bone marrow examination
- Other tests