0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
898 Leukocytosis: Neutrophil➣Chronic idiopathic neutrophilia
sporadic condition
Laboratory evaluation:
WBC 11,000–40,000/microliter, neutrophilic predomi-
nance
Clinical course benign.
➣Leukocyte adhesion deficiency
Rare autosomal dominant disorder
Recurrent life-threatening bacterial and fungal infections
Cutaneous abscesses, gingivitis, periodontal infections
Caused by deficient expression CD11b/CD18, failure of
chemotaxis
Treated with antibiotics
Severe cases: allogeneic stem cell transplantationAcquired Neutrophilia
■Secondary to other disease process
➣Infection
Acute
Most common cause of an elevated leukocyte count is infec-
tion.
May be accompanied by increased immature precursors
(“left shift”)
More common with bacterial infection, can also occur with
viral processes.
Morphologic changes in the neutrophil with bacterial infec-
tion
Toxic granulation, Dohle bodies, and cytoplasmic vac-
uoles
Resolves with treatment or resolution of the infectious pro-
cess
Chronic
Increased marrow granulocyte production
Sometimes with monocytosis (especially with mycobacte-
ria, fungus)
Leukemoid reaction
Seen with chronic infections (osteomyelitis, empyema,
mycobacteria)
WBC markedly elevated (>50,000)
Associated with a marked left shift