My brother’s leukocyte count is persistently high. Why?

Question

Hello 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 a few myelocytes and metamyelocytes. The USG of the abdominal area also revealed moderate hepatosplenomegaly.

He also had increased uric acid, SGPT, and LDH levels. 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%.
Peripheral smear: Neutrophilic leukocytosis and a few atypical lymphocytes are present.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

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.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

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 the possibility of CML.

I hope this helps you.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I have reviewed the results of your brother's CBC (attachment removed to protect patient identity).

No erythrocytosis, thrombocytosis, or anemia 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 and has no sweating or weight loss). So, this argues against the presence of malignancy.

On the differential count, one promyelocyte is visible, but there are still no blasts. For now, I would advise you to await the PCR results for mutation. You have actually completed the most significant test to exclude a diagnosis of CML. So, all that remains is to wait calmly.

I am always here for you if you have any questions, and I hope this message brings you some comfort and reassurance.

Regards.