0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
Leukocytosis: Neutrophil 899➣Acute Stress
Causes demargination of neutrophils, mediated by adrenergic
stimulation
Common stresses: exercise, surgery, seizure, and myocardial
infarction.
➣Drugs
Steroids
Increase marrow release of mature neutrophils
Should not cause left shift
Beta agonists
Induce demargination of neutrophils adherent to endothe-
lium
White blood cell count may double
Lithium
Causes chronic elevation of white count
Cytokine stimulation (e.g., G-CSF)
Stimulate marrow production of neutrophils
Can cause dramatic elevations in the white blood count
Majority of cells are neutrophils, often with left shift
➣Chronic Inflammation
➣Primary hematologic abnormalities
Myelophthysis
Non-hematologic malignancies (lung and breast common)
Tumors metastatic to the marrow may cause leukoerythrob-
lastic changes
Marrow hyperstimulation
Chronic hemolysis, immune thrombocytopenia
May reflect disease activity, steroid therapy, or splenec-
tomy
Recovery from marrow suppression
Myeloproliferative disease
Frequently associated with elevated hematocrit and platlets
as well
Elevated eosinophil and basophil counts often seen
Frequently associated with splenomegaly
LAP may be low or undetectable in chronic myelogenous
leukemia.
➣Altered margination
Post-splenectomy
Sickle cell disease