Leukemoid reaction–A tale of 50 years

Mandal, Piali; Mukherjee, Sharmila Banerjee

doi:10.1007/s13312-015-0755-2

Cited by 9 publications

(8 citation statements)

References 6 publications

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“…Additionally, much of the literature was written when the incidence of diseases was rather different and diagnosing myeloproliferative disease was difficult. The main causes of LR are severe infection, toxin exposure, neoplasms, severe hemorrhage, and acute hemolysis . LR may also occur from exposure to glucocorticoids, minocycline, and growth factors, as well as to toxic substances such as ethylene glycol…”

Section: Introductionmentioning

confidence: 99%

“…Diagnosing paraneoplastic leukemoid reaction (PLR) is a challenge, since infections, other neoplasms, and simple response to corticosteroids must be excluded. Solid neoplasms most commonly associated with PLR are lung and kidney, but a variety of tumors is described . Although treating the underlying tumor often decreases leukocyte counts, PLR is associated with a more aggressive disease course …”

Section: Introductionmentioning

confidence: 99%

“…Solid neoplasms most commonly associated with PLR are lung and kidney, 13,15,16 but a variety of tumors is described. [12][13][14][15][16][17][18][19][20][21][22] Although treating the underlying tumor often decreases leukocyte counts, PLR is associated with a more aggressive disease course. 14,15,20,21,23 Leukemoid reactio is a rare but relevant hematologic finding in CBC.…”

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confidence: 99%

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Leukemoid reaction: A 21st‐century cohort study

Portich

Faulhaber

2019

Int J Lab Hematology

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Introduction Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes. Methods This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan‐Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death. Results Of the 267 cases with white blood cell count of >50 × 109, 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log‐rank [Mantel‐Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death. Conclusions This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Leukemoid reaction: A 21st‐century cohort study

Portich

Faulhaber

2019

Int J Lab Hematology

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“…LR is a common haematological entity defined as a leukocyte count ≥ 50,000 cells/µl, predominantly featuring mature neutrophils and a left side shift3. In most circumstances, the cause for LR is evident but our case represented a rare scenario in that LR, with a TLC ≥100,000 cells/µl, was misdiagnosed as leukemia4,5. It is crucial for clinicians and haematopathologists to distinguish this condition from leukaemia and other myeloproliferative disorders for therapeutic purposes and to avoid causing undue fear among patients and their families caused by a cancer diagnosis.…”

Section: Discussionmentioning

confidence: 80%

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

Jumanne

2019

Mal. Med. J

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BackgroundNecrotizing pneumonia and hyperleukocytosis, to the extent of that seen in leukaemia, is a rarely reported presentation. The commonest trigger of such a presentation is an inflammatory process caused by an overwhelming infection which leads to bone marrow irritation. However, the misdiagnosis of this clinical entity as leukaemia should be avoided at all costs so as to avoid the anxiety associated with a diagnosis of cancer, both to the patients and their families.Case presentationHere, we report the case of a 22-month-old boy who was referred to our Pediatric Oncology Unit (POU). Owing to a high total leukocyte count (TLC) of 98,000 cells/µl, there was a strong suspicion of leukaemia. The boy had been reviewed at another hospital where he presented with fever and cough refractory to the commencement of tuberculosis medications as a result of chest radiography findings. Laboratory investigations performed on admission in the POU were negative for leukaemia and other myeloproliferative disorders. A chest computer tomography (CT) scan was performed to delineate opacification in the right middle lobe. This revealed multiple necrotic and emphysematous foci in line with a diagnosis of necrotizing pneumonia. Subsequently, the patient responded well to a course of piperacillin- tazobactam. The TLC normalized and the cough and fever resolved over a period of 2 weeks. ConclusionHere, we describe a particularly rare case of leukaemoid reaction with a massive leukocyte count. Such patients can be easily misdiagnosed as having leukaemia or other myeloproliferative disorders, especially in settings with limited diagnostic availability. Such misdiagnosis can cause undue stress on the patient and their families. Thus, it is important that patients presenting with these symptoms should undergo a thorough review of history, physical examination and a structured workup.

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“…If CML is suspected but the Ph1 chromosome and BCR-ABL1 fusion transcript are absent, non-malignant disorders with a clinical and hematological picture mimicking CML need to be excluded first. Leukemoid reaction (LR) is the major differential diagnosis of CML in patients presenting with a leukocyte count in the range of 50,000 cells/µL and significant increase in mature neutrophils with a marked shift to the left [31]. Laboratory findings like toxic granulocytic vacuolation, Döhle's bodies in the granulocytes, absence of basophilia, and a normal or increased leukocyte alkaline phosphatase (LAP) score separate the LR from CML [32].…”

Section: Differential Diagnosismentioning

confidence: 99%

Definition, Epidemiology, Pathophysiology, and Essential Criteria for Diagnosis of Pediatric Chronic Myeloid Leukemia

Suttorp

Millot

Sembill

et al. 2021

Cancers

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Depending on the analytical tool applied, the hallmarks of chronic myeloid leukemia (CML) are the Philadelphia Chromosome and the resulting mRNA fusion transcript BCR-ABL1. With an incidence of 1 per 1 million of children this malignancy is very rare in the first 20 years of life. This article aims to; (i) define the disease based on the WHO nomenclature, the appropriate ICD 11 code and to unify the terminology, (ii) delineate features of epidemiology, etiology, and pathophysiology that are shared, but also differing between adult and pediatric patients with CML, iii) give a short summary on the diseases to be considered as a differential diagnosis of pediatric CML, (iv) to describe the morphological, histopathological and immunophenotypical findings of CML in pediatric patients, (v) illustrate rare but classical complications resulting from rheological problems observed at diagnosis, (vi) list essential and desirable diagnostic criteria, which hopefully in the future will help to unify the attempts when approaching this rare pediatric malignancy.

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Leukemoid reaction–A tale of 50 years

Cited by 9 publications

References 6 publications

Leukemoid reaction: A 21st‐century cohort study

Leukemoid reaction: A 21st‐century cohort study

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

Definition, Epidemiology, Pathophysiology, and Essential Criteria for Diagnosis of Pediatric Chronic Myeloid Leukemia

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