White Blood Cells

Leukocytopenia

Pancytopenia

Production

  • Iatrogenic, e.g. chemotherapy

  • Infection

    • Viral

      • Epstein-Barr virus (EBV)

      • Hepatitis

      • HIV

    • Tuberculosis

  • Autoimmune

    • Rheumatoid arthritis

    • Systemic lupus erythematosus

    • Sarcoidosis

  • Malignancy

    • Multiple myeloma

    • Leukemia

Consumption

  • Splenomegaly (multiple etiologies)

  • Disseminated intravascular coagulation

Neutropenia

  • Definitions

    • Neutropenia: ANC < 1500 cells/microL

    • Severe neutropenia (ANC < 500): Initiate neutropenic precautions (see below)

    • Agranulocytosis: ANC < 200 cells/microL

  • Etiologies

    • Benign ethnic neutropenia (most common)

    • Nutritional deficiency, e.g. B12, folate

    • Viral illness

    • Liver cirrhosis

    • Autoimmune disorder

    • Pancytopenia (see above)

    • Medication-induced, e.g. antibiotics, anti-inflammatories including NSAIDs, clozapine, tricyclic antidepressants, thyroid medications, sulfonylureas

Leukocytosis

Lymphocytosis

  • More coming soon

Neutrophilic Leukocytosis

Pt with h/o smoking, irritable bowel disease, hepatitis, rheumatic disease, granulomatous disease, vasculitis, sickle cell s/p splenectomy presents with new onset neutrophilia. Reports recent sick contacts, febrile seizures, panic attacks, surgery. Denies chronic fever, fatigue, weight loss, night sweats, pregnancy. Medications include corticosteroids, beta agonists, lithium, epinephrine, colony-stimulating factors. Fever on exam. No bruising, lymphadenopathy, splenomegaly noted.

  • Labs

    • Neutrophils >60% and 7,000/mm^3; obtain repeat CBC to confirm result

    • Obtain peripheral smear

      • Evaluate for hemolytic anemia, ITP

      • Rule out presence of blasts

    • Obtain ESR, CRP, ANA, blood cultures

    • Consider lumbar puncture

  • Consider empiric antibiotics


Notes

  • Neutrophilia may be normal in patients with h/o splenectomy, smoking

  • Congenital conditions such as Down Syndrome may result in neutrophilia

  • Neutrophilia etiologies include physiologic stressors including pregnancy, bone marrow stimulation, acute infection

  • Factors that increase concern for malignancy include chronic fever, fatigue, weight loss, night sweats


Monocytosis

  • Infectious, e.g. EBV, tuberculosis

  • Autoimmune disease

  • Chronic myelogenous leukemia