Question 9.3

Last updated Fri, 04/28/2017 - 19:28
 Topic: Haematology and Oncology
Pass rate
70%
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A 54 year old lady presented to the emergency department after having been unwell for 4 days. Her Full Blood Count (FBC) report is provided below.

Hb

* 128     g/L

(130 – 180)
WBC * 56.51  X109/L (3.50 - 11.00)
Platelet 347     X109/L (150 - 450)

RBC

5.27    X1012/L

(4.50 - 6.50)

HCT

0.414

(0.40 - 0.54)

MCV

82.6    fL

(80 – 100)

MCH

* 26.3    pg

(26.5 - 33.0)

MCHC

310     g/L

(310 – 360)

NEUTROPHIL

(96.3 %) * 54.40 X10^9/L

(1.7 - 7.0)

LYMPHOCYTE

(2.8 %) 1.60 X10^9/L

(1.5 - 4.0)

MONOCYTE

(0.7 %) 0.44 X10^9/L

(0.1 - 0.8)

EOSINOPHIL

(0.1 %) 0.05 X10^9/L

(0.04 - 0.44)

BASOPHIL

(0.1 %)0.02 X10^9/L

(0.00 - 0.20)

Moderate rouleaux. Marked neutrophilia. Dohle bodies present, toxic granulation present

a. What likely haematological  process  is revealed by the abnormal white cell and neutrophil count?

b. Cite 3 features on this FBC which support your answer in (a)

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College Answer

a. What likely haematological  process  is revealed by the abnormal white cell and neutrophil count ?

1) A leukemoid reaction.

b. Cite 3 features on this FBC which support your answer in (a)
>50000 cells
Normal basophil and eosinophil count. Presence of Döhle bodies
Presence of toxic granulation

Discussion

Abnormal blood film findings and leukemoid reactions are discussed in greater detail elsewhere.

The presence of Döhle bodies is not exactly diagnostic, but their contribution to the overall picture of "toxic change" is consistent with a leukemoid reaction. In general, "Persistent neutrophilic leukocytosis above 50,000 cells/μL when the cause is other than leukemia defines a leukemoid reaction".  In this situation the college has not made the absence of leukaemia abundantly obvious, but the normal counts of all other cellular lineages suggest that bone marrow suppression by malignant infiltration is probably not taking place.

Causes of Leukemoid Reaction
  • Infection
    • Pneumonia
    • Tuberculosis
    • Pertussis
    • AIDS/HIV
  • Drugs
    • Corticosteroids
    • G-CSF
  • Increased neutrophil release
    • Stress
    • Trauma
    • Exercise
    • Sepsis
  • Inflammatory conditions
    • Empyema
  • Malignancy
    • Myeloproliferative disorders
    • Myeloid leukaemia
    • Lymphoma
    • Solid tumours, eg. lung
  • Decreased neutrophil clearance
    • Splenectomy

References

Weiner, W., and Elizabeth Topley. "Döhle bodies in the leucocytes of patients with burns." Journal of clinical pathology 8.4 (1955): 324-328.

Sakka, Vissaria, et al. "An update on the etiology and diagnostic evaluation of a leukemoid reaction." European journal of internal medicine 17.6 (2006): 394-398.

ul Haque, Anwar, and Noor ul Aan. "Leukemoid Reaction: Unusual Causes." International Journal of Pathology 8.1 (2010): 39-40.

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