Page 795 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 48 Neutrophilic Leukocytosis, Neutropenia, Monocytosis, and Monocytopenia 681

Because leukemic progression with or without death from infection is Aster RH: Adverse drug reactions affecting blood cells. Handb Exp Pharmacol
high, stem cell transplantation is recommended when feasible. When 57, 2010.
a family member is used as a BM donor, GATA2 sequencing must be Bhatt V, Saleem A: Review: drug-induced neutropenia: pathophysiology,
performed to rule out asymptomatic carrier status before donating. clinical features and management. Ann Clin Lab Sci 34:131, 2004.
When monocytopenia out of proportion to neutropenia is detected Dale DC, Bolyard AA, Schwinzer BG, et al: The severe chronic neutropenia
in a patient with or without human papillomavirus-associated warts international registry: 10-Year follow-up report. Support Cancer Ther
or MAC infection, examination of B- and NK-cell count by flow 3:220, 2006.
cytometry will be informative. Detailed family history may reveal Dale DC, Link DC: The many causes of severe congenital neutropenia. N
additional patients with infectious complications or MDS/AML. Engl J Med 360:3, 2009.
Donadien J, Fenneteau O, Beaupain B, et al: Congenital neutropenia:
diagnosis, molecular bases and patient management. Orphanet J Rare
Chronic Mild Neutrophilic Leukocytosis Dis 6:26, 2011.
Freifeld AG, Bow EJ, Sepkowitz KA, et al: Clinical practice guideline for the
A 46-year-old man was referred to the hematology clinic for evaluation use of antimicrobial agents in neutropenic patients with cancer: 2010
of neutrophilia that was noted by his primary care physician on a
routine blood test. He reported no fevers, chills, or night sweats. He had Update by the Infectious Diseases Society of America. Clin Infect Dis
good energy and was working full time as a lawyer. He denies fatigue, 52:e56, 2011.
weight loss, or rashes. His past medical history included hypertension Gasche C, Reinisch W, Schwarzmeimer JD: Evidence of colony suppressor
and obesity, but was otherwise healthy. He has been an active smoker activity and deficiency of hematopoietic growth factors in hairy cell
for 10 years. Family history was negative for blood diseases. Vital signs leukemia. Hematol Oncol 11:97, 1993.
2
were normal. Body mass index was 40.5 kg/m . Physical examination Gibson C, Berliner N: How we evaluate and treat neutropenia in adults.
revealed only an obese abdomen. Laboratory values showed WBC Blood 124:1251–1258, 2014.
3
3
12,500/mm , ANC 8500/mm , Hb 14 g/dL, hematocrit (Hct) 42%, Haas P, Straub R, Beoui S, et al: Peripheral but not central leptin treatment
3
platelets 400 K/mm . Chemistries were unremarkable. Peripheral increases numbers of circulating NK cells, granulocytes and specific
blood smear showed only increased neutrophils, with unremarkable
RBCs and platelets. A complete blood cell count 2 years ago showed monocyte subpopulations in non-endotoxaemic lean and obese LEW-rats.
3
3
WBC 11,800/mm , ANC 8100/mm , Hb 14.2 g/dL, platelets 385 K/ Regul Pept 51:26, 2008.
3
mm . What is the next step in evaluation? Herishanu Y, Rogowski O, Polliack A, et al: Leukocytosis in obese individu-
This patient has mild neutrophilia of at least 2 years of duration. als: possible link in patients with unexplained persistent neutrophilia. Eur
Obesity and smoking are common causes of neutrophilia. There is no J Haematol 76:516, 2006.
evidence of chronic infection, inflammation or hematologic malignancy. Hsieh MM, Everhart JE, Byrd-Holt DD, et al: Prevalence of neutropenia in
No further work up is warranted, only follow-up, at the present time. the U.S. population: age, sex, smoking status, and ethnic differences. Ann
Intern Med 146:486, 2007.
Hsieh MM, Tisdale JF, Rodgers GP, et al: Neutrophil count in African
Acute Severe Neutrophilic Leukocytosis Americans: lowering the target cutoff to initiate or resume chemotherapy?
J Clin Oncol 28:19, 2010.
A 78-year-old woman nursing home resident presented to the emer- Koskela HL, Eldfors S, Ellonen P, et al: Somatic STAT3 mutations in large
gency department with altered mental status, diarrhea, and abdominal granular lymphocytic leukemia. N Engl J Med 366:20, 2012.
pain. She was recently treated with ciprofloxacin for urinary tract infec- Kroft SH: Infectious diseases manifested in the peripheral blood. Clin Lab
tion. On physical examination, she is difficult to arouse. Vital signs Med 23:253, 2003.
show blood pressure 105/66 mmHg, heart rate 98/min, respiratory Marchetti M, Falanga A: Leukocytosis, JAK2V617F mutation, and hemosta-
rate 18/min, temperature of 100.4°F. Abdominal examination reveals
distension, active bowel sounds, no organomegaly. Laboratory findings sis in myeloproliferative disorders. Pathophysiol Haemost Thromb 36:148,
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show WBC 88,000/mm , Hb 10.5g/dL, platelets 200/mm , neutrophils 2008.
65%, lymphocytes 5%, monocytes 4%, eosinophils <1%, basophils Nagareddy PR, Kraakman M, Masters SL, et al: Adipose tissue macrophage
<1%, bands 25%. Hematology is consulted for the high WBC. Periph- promote myelopoiesis and monocytosis in obesity. Cell Metab 6:19, 2014.
eral blood smear shows increased neutrophils, metamyelocytes, and Neureiter D, Kemmerling R, Ocker M, et al: Differential diagnostic challenge
myelocytes. RBCs are normocytic and normochromic. Platelets are of chronic neutrophilic leukemia in a patient with prolonged leukocytosis.
unremarkable. Nursing home records show normal blood counts J Hematop 1:23, 2008.
except mild anemia with a Hb of 10.9 g/dL a month ago. Plo I, Zhang Y, Couedic JL, et al: An activating mutation in the CSF3R gene
The almost certain cause of the extreme leukocytosis in this patient induces a hereditary chronic neutrophilia. J Exp Med 206:1701, 2009.
is leukemoid reaction, perhaps due to urosepsis. Clostridium difficile
infection is classically associated with severe neutrophilia and the Rajala HL, Eldfors S, Kuusanmäki H, et al: Discovery of somatic STAT5b
recent antibiotic use with diarrhea and abdominal distention suggests mutations in large granular lymphocytic leukemia. Blood 121:4541, 2013.
this as another possibility. The absence of splenomegaly, eosinophilia, Rice L, Harris RL, Lynch EC, et al: Utility of peripheral blood changes in
and basophilia, and near normal blood counts a month ago makes discriminating causes of fever and infection. Blood 70:94A, 1987.
CML or other MPN very unlikely. We would recommend appropriate Rice L, Shenkenberg T, Wheeler T, et al: Opportunistic granulomatous infec-
antibiotics, clinical follow-up, but no molecular testing at this time. tions in hairy cell leukemia. Cancer 49:1924, 1982.
Seshadri RS, Brown EJ, Zipursky A: Leukemic reticuloendotheliosis. A failure
of monocyte production. N Engl J Med 295:181, 1977.
SUGGESTED READINGS Spinner MA, Sanchez LA, Hsu AP, et al: GATA2 deficiency: a protein
disorder of hematopoiesis, lymphtics, and immunity. Blood 123:6, 2014.
Aapro MS, Bohlius J, Cameron DA, et al: 2010 Update of EORTC guide- Tesfa D, Keisu M, Palmblad J: Idiosyncratic drug-induced agranulocytosis:
lines for the use of granulocyte-colony stimulating factor to reduce the possible mechanisms and management. Am J Hematol 84:428, 2009.
incidence of chemotherapy-induced febrile neutropenia in adult patients Weick JK, Hagedorn AB, Linman JW: Leukoerythroblastosis. Diagnostic and
with lymphoproliferative disorders and solid tumours. Eur J Cancer 47:8, prognostic significance. Mayo Clin Proc 49:110, 1974.
2011. Wolach O, Bairey O, Lahav M: Late-onset neutropenia after rituximab treat-
Akhtari M, Curtis B, Waller E: Autoimmune neutropenia in adults. Autoim- ment: case series and comprehensive review of the literature. Medicine
mun Rev 9:62, 2009. (Baltimore) 89:308, 2010.