Page 1121 - Williams Hematology ( PDFDrive )

1096 Part VIII: Monocytes and Macrophages Chapter 70: Monocytosis and Monocytopenia 1097

TABLE 70–1. Disorders Associated with Monocytosis
I. Hematologic Disorders B. Infections
A. Myeloid neoplasms 1. Mycobacterial infections 59–62
1. Myelodysplastic syndromes 12–16 2. Subacute bacterial endocarditis 63–65
2. Primary myelofibrosis 17 3. Brucellosis 66
3. Acute monocytic leukemia 18,19 4. Dengue hemorrhagic fever 67
4. Acute myelomonocytic leukemia 20 5. Resolution phase of acute bacterial infections 68
5. Acute monocytic leukemia with histiocytic features 21 6. Syphilis 69,70
6. Acute myeloid dendritic cell leukemia 22–24 7. Cytomegalovirus infection 71
7. Chronic myelomonocytic leukemia 25–27 8. Varicella-zoster virus 72
8. Juvenile myelomonocytic leukemia 28 9. Influenza 73
9. Chronic myelogenous leukemia (m-BCR–positive type) 29,30 III. Gastrointestinal Disorders
10. Polycythemia vera 11 A. Alcoholic liver disease 74
11. Primary myelofibrosis 17 B. Inflammatory bowel disease 75
B. Chronic neutropenias 31–36 C. Sprue 11
C. Drug-induced neutropenia 37–39 IV. Nonhematopoietic Malignancies 76–79
D. Postagranulocytic recovery 40,41 V. Exogenous Cytokine Administration 80–86
E. Lymphocytic neoplasms VI. Myocardial Infarction 87–90
1. Lymphoma 43 VII. Cardiac Bypass Surgery 91
2. Hodgkin lymphoma 44,45 VIII. Miscellaneous Conditions
3. Myeloma 46,47 A. Tetrachloroethane poisoning 92
4. Macroglobulinemia 48 B. Parturition 93,94
5. T-cell lymphoma 49,50 C. Glucocorticoid administration 95–98
6. Chronic lymphocytic leukemia 51 D. Depression 99–101
F. Drug-induced pseudolymphoma 52 E. Thermal injury 102,103
G. Immune hemolytic anemia 11 F. Marathon running 104,105
H. Idiopathic thrombocytopenic purpura 11 G. Holoprosencephaly 106
I. Postsplenectomy state 53,54 H. Kawasaki disease 107
II. Inflammatory and Immune Disorders I. Wiskott-Aldrich syndrome 108
A. Connective tissue diseases J. Hemodialysis 109
1. Rheumatoid arthritis 55
2. Systemic lupus erythematosus 56
3. Temporal arteritis 11
4. Myositis 11
5. Polyarteritis nodosa 11
6. Sarcoidosis 57,58

HEMATOLOGIC DISORDERS have, by definition, an increased absolute number of monocytes in the
blood (≥1.0 × 10 /L). The monocytosis may be more striking in some
9
Approximately 25 percent of patients with a myelodysplastic syn- cases. 25–27 Juvenile myelomonocytic leukemia, also, is defined in part by
drome have an increase in the absolute monocyte count. 12–16 Occasional the increased number of monocytes in the blood and marrow. In some
28
patients with a myelodysplastic syndrome may develop an absolute cases of acute monocytic leukemia, the monocytes are immature and
monocyte count as high as 30,000/μL (30 × 10 /L). Chronic monocyto- have features of monoblasts or promonocytes, but in some cases they
9
sis may be the principal feature of a clonal myeloid disease and precede are indistinguishable by light microscopy from normal blood mono-
by years the development of acute myelogenous leukemia. Patients with cytes. Some automated instruments are dependent on the α-naphthol
myelodysplasia and monocytosis have a high propensity to evolve into acetate esterase reaction to detect the proportion of monocytes in white
acute or chronic myelomonocytic leukemia. Monocytosis, as a feature cell differential counts. These instruments may underestimate leukemic
17
of primary myelofibrosis, may be a harbinger of rapid progression. monocytes counts, especially in cases of chronic myelomonocytic leu-
The number of promonocytes and monocytes in blood and marrow kemia, because the leukemic monocytes have a decreased activity of the
may be increased in patients with acute myelogenous leukemia of the enzyme. An uncommon variant of Ph-positive chronic myelogenous
25
monocytic 18,19 or myelomonocytic type. Acute myelogenous leukemic leukemia (CML), expressing a p190 BCR-ABL transcript, is associated
20
cells with a histiocytic (macrophagic) or dendritic cell phenotype have with a striking monocytosis in approximately 50 percent of cases. 29,30
21
been described. 22–24 Patients with chronic myelomonocytic leukemia

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