Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Leukocytosis: Neutrophil 897

Signs & Symptoms

■Vital signs, especially to exclude fever

■Evidence of adenopathy, hepatosplenomegaly

■Peripheral stigmata of infection

tests

Peripheral Blood Studies

■Repeat CBC to rule out laboratory error or transient leukocytosis

■Leukocyte alkaline phosphatase (LAP) score: 0 or near zero in CML,

elevated in infection

■Examination of the peripheral smear

➣Morphology of the neutrophils-evidence of toxic granulation,

immature forms

➣Erythrocyte morphology

Leukoerythroblastic picture

fragmented erythrocytes, teardrops, and nucleated red cells

suggests myelophthysic involvement of the bone marrow

suspicious for granulomatous disease, tumor, myeloprolifera-

tive disease

Bone Marrow Studies

■Usually unnecessary in evaluation of neutrophilia

■Indicated in setting of leukoerythroblastic changes

■Studies should include

➣cytogenetics, especially for Philadelphia chromosome

➣marrow culture, especially for mycobacteria, fungus

➣stem cell culture for cytokine-independent colony growth

(marker of myeloproliferative dx)

differential diagnosis

Hereditary Neutrophilia

■Congenital

➣Hereditary neutrophilia

Autosomal dominant

Leukocytosis, splenomegaly, and widened diploe of the skull

Laboratory evaluation:

WBC 20,000–70,000/microliter

Elevated LAP

Clinical course benign.