Dr. Elina Angelova Beleva
Hematology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My brother was admitted to the hospital after he was diagnosed with dengue. However, there was concurrent evidence of severe leukocytosis (WBC >45,000 and neutrophils >70 %) and also few myelocytes and metamyelocytes. The USG of the abdomen area also revealed moderate hepatosplenomegaly. He also had an increased uric acid, SGPT, and LDH level. In the course of time, the leucocyte count was persistently high (>30,000) but with a gradually decreasing trend. The fever gradually subsided. Urine and blood C/S were negative. Yesterday's hematology report was: WBC count: 34,500. Differential Count: Neutrophil: 79 %, lymphocyte: 19 %, monocyte: 01 %, eosinophil: 01 %, basophil: 00 % and peripheral smear: neutrophilic leukocytosis, and few atypical lymphocytes present.
Hello,
Welcome to icliniq.com.
In case of a severe infection, an elevation of the white blood cell count (WBC) is expected and it can reach up to 100 g/L, also described as a leukemoid reaction. This is not a blood cancer and denotes the presence of mature neutrophils on the peripheral smear due to the heightened demand for neutrophils to combat infection (as in your brother's case).
Also, lymphopenia can be present in case of a viral infection with the appearance of so-called atypia or activation.
The fact that the WBC count subsides with the resolution of infection speaks in favor of this reactive condition.
Patient's Query
Hello doctor,
Thank you for your reply. He will be undergoing CBC and manual DBC tests frequently. We were also told to have BCR-ABL test for checking the presence of chronic myeloid leukemia. I am very worried about the results of this test. I do not know what the results will be.
Hello,
Welcome back to icliniq.com.
It would be plausible to consider chronic myeloid leukemia (CML) if your brother's spleen is enlarged and if the WBC count steeply elevates with the persistence of symptoms. An extreme leukocytosis of >100 g/L is characteristic as is the appearance of immature cells like myeloblasts on the blood smear (which is not the dynamics in this case).
If you have undergone the BCR-ABL test, that is good, since it would almost absolutely exclude a possibility for CML.
Regards.
Patient's Query
Hello doctor,
Thank you for your reply. He got a blood test done today also. The WBC count has again increased. I have attached the report. Is this getting worrisome? The BCR-ABL test results will arrive on Saturday. He is having no symptoms. He is feeling very healthy and not at all fatigued. His appetite is also absolutely normal.
Hello,
Welcome back to icliniq.com.
I have reviewed the results of your brother's CBC (attachment removed to protect patient identity).
There is no erythrocytosis, thrombocytosis or anemia that could be related to the presence of a myeloproliferative disorder (such as CML). The WBC increase is insignificant and he has no biologic symptoms (he is eating well, has no sweating or weight loss). So this argues against the presence of malignancy.
On the differential count, there is one promyelocyte to be seen, but still no blasts. For now, I would advise you to await the PCR results for mutation. You have actually completed the most significant test in order to exclude a diagnosis of CML. So, all there is left to be done is to wait calmly.
Regards.
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