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Leukocytosis — Clinical Guidelines

Overview

Leukocytosis refers to an elevated white blood cell (WBC) count, commonly observed in clinical settings and can indicate various underlying conditions ranging from benign to malignant processes. 2

Diagnosis

Initial Assessment: Confirm WBC count and differential using automated analyzers and peripheral blood (PB) smear examination. 2

Differential Diagnosis: Distinguish between myeloid and lymphoid leukocytosis. Manual differential is crucial for identifying specific pathologies. 2

Flow Cytometry: Useful for confirming lymphoproliferative disorders by examining lymphocyte morphology and identifying pleomorphic versus monomorphic populations. 2

Bone Marrow Examination: Indicated for suspicious lymphoblastic populations to rule out precursor lymphoid neoplasms. 2

Species-Specific Reference Ranges: Essential for accurate interpretation, especially in non-human species like keeled box turtles, where established norms differ significantly. 1

Automated Flagging Criteria: Optimize flagging thresholds using statistical analysis and clinical judgment to improve diagnostic accuracy and reduce unnecessary manual reviews. 4

Management

Malignant Leukocytosis: Initiate specific treatment based on identified malignancy (e.g., chemotherapy for leukemias). 2

Benign Leukocytosis: Address underlying causes such as infection or inflammation with appropriate antimicrobial or anti-inflammatory therapies. 2

Cytapheresis: Effective for managing hyperleukocytosis (WBC >150 x 10^9/L) and thrombocytosis, reducing cell counts significantly without bone marrow remission. 5

Monitoring: Regular CBC monitoring is crucial, especially in asymptomatic patients with persistent leukocytosis to track clinical progression. 1

Special Populations

Non-Human Species: Establish species-specific hematologic reference ranges to accurately interpret leukocytosis in animals like keeled box turtles. 1

Key Recommendations

Confirm leukocytosis with automated WBC counts and manual differential analysis to differentiate between benign and malignant causes. (Evidence: Strong 2)

Utilize flow cytometry for detailed examination of lymphocyte populations in suspected lymphoproliferative disorders. (Evidence: Moderate 2)

Optimize automated cell counter flagging thresholds using statistical methods to enhance diagnostic efficiency and reduce manual workload. (Evidence: Moderate 4)

Consider cytapheresis for managing severe hyperleukocytosis to mitigate leukostasis risks effectively. (Evidence: Weak 5)

Regular monitoring of CBC in asymptomatic patients with persistent leukocytosis is essential for early detection of clinical changes. (Evidence: Expert opinion 1)

References

1 Cerreta AJ, Houck EL, Stowe DM, Lewbart GA. Hematology of the keeled box turtle (Cuora mouhotii). Veterinary clinical pathology 2020. link 2 George TI. Malignant or benign leukocytosis. Hematology. American Society of Hematology. Education Program 2012. link 3 Roussel M, Benard C, Ly-Sunnaram B, Fest T. Refining the white blood cell differential: the first flow cytometry routine application. Cytometry. Part A : the journal of the International Society for Analytical Cytology 2010. link 4 Sireci A, Schlaberg R, Kratz A. A method for optimizing and validating institution-specific flagging criteria for automated cell counters. Archives of pathology & laboratory medicine 2010. link 5 Balint B, Ostojic G, Pavlovic M, Hrvacevic R, Pavlovic M, Tukic L et al.. Cytapheresis in the treatment of cell-affected blood disorders and abnormalities. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis 2006. link 6 Arroyo ME, Tabernero MD, García-Marcos MA, Orfao A. Analytic performance of the PENTRA 80 automated blood cell analyzer for the evaluation of normal and pathologic WBCs. American journal of clinical pathology 2005. link 7 Lohmann RC, Wood DE, Jacobs WI, Elliott ML. Reliability of white blood cell counting. Archives of pathology & laboratory medicine 1989. link 8 Ketelaar R, Elion-Gerritzen WE. A microcomputer network for the differential leucocyte count and the registration of red blood cell morphology. Clinical and laboratory haematology 1987. link 9 Peebles D, Kirchanski S, Brown M, Hoffman R. Extended leukocyte parameters for hematology analyzers. Annals of the New York Academy of Sciences 1986. link 10 Korpman RA, Bull B. Whither the WBC differential?--some alternatives. Blood cells 1980. link

Leukocytosis