From the Guidelines
Elevated Polymorphonuclear leukocytes (PMNs) indicates an active inflammatory or infectious process in the body, and a PMN count of 250 cells/mm3 or higher in ascitic fluid is a reliable indicator of spontaneous bacterial peritonitis (SBP) and warrants empiric antibiotic therapy. PMNs, which include neutrophils, eosinophils, and basophils (with neutrophils being the most abundant), are white blood cells that serve as the body's first line of defense against infections. When their levels rise above the normal range (typically 1,500-8,000 cells per microliter for neutrophils), it usually suggests that the immune system is responding to a bacterial infection, tissue damage, or inflammation. Common causes include bacterial infections like pneumonia or urinary tract infections, inflammatory conditions, physical trauma, surgery, burns, or certain medications. The elevation occurs because the bone marrow increases production and releases these cells into the bloodstream to fight the infection or address the inflammation. In some cases, elevated PMNs may also indicate more serious conditions like leukemia or other blood disorders. If you have elevated PMNs, your healthcare provider will likely investigate the underlying cause through additional tests and develop a treatment plan targeting the specific condition rather than the elevated PMN count itself, as recommended by studies such as 1.
Key Points to Consider
- Elevated PMN count in ascitic fluid is a reliable indicator of SBP and warrants empiric antibiotic therapy, as stated in 1 and 1.
- A PMN count of 250 cells/mm3 or higher is considered a threshold for diagnosing SBP, as mentioned in 1 and 1.
- Empiric antibiotic therapy should be initiated promptly in patients with suspected SBP, as recommended by 1 and 1.
- The choice of antibiotic therapy, such as cefotaxime, should be guided by the severity of the infection and the patient's underlying condition, as discussed in 1 and 1.
Management and Treatment
- Patients with ascites admitted to the hospital should undergo abdominal paracentesis, as recommended by 1 and 1.
- Patients with ascitic fluid PMN counts >250 cells/mm3 should receive empiric antibiotic therapy, as stated in 1.
- Oral ofloxacin can be considered a substitute for intravenous cefotaxime in certain cases, as mentioned in 1.
From the Research
Elevated Polymorphonuclear Leukocytes (PMNs)
Elevated PMNs, also known as neutrophilia, can be an indication of various conditions, including:
- Infections, such as bacterial or fungal infections 2
- Inflammatory diseases, such as arthritis or gout
- Tissue damage or trauma
- Certain types of cancer, such as leukemia
- Reaction to certain medications
Causes of Elevated PMNs
The causes of elevated PMNs can be diverse and may include:
- Bacterial infections, which can trigger an increase in PMN production 2
- Sepsis, a life-threatening condition that occurs when the body's response to an infection becomes uncontrolled 3
- Inflammatory responses, which can lead to an increase in PMN production 4
- Tissue damage or trauma, which can trigger an inflammatory response and increase PMN production
Effects of Elevated PMNs
Elevated PMNs can have various effects on the body, including:
- Increased risk of tissue damage and inflammation 5
- Impaired immune function, making it harder for the body to fight off infections 2
- Increased risk of sepsis and other life-threatening conditions 3
- Potential for NETs (neutrophil extracellular traps) to exacerbate tissue damage during inappropriate inflammation 5
Relationship between PMNs and Neutropenia
It's worth noting that elevated PMNs are the opposite of neutropenia, a condition characterized by low levels of neutrophils in the blood 6. Neutropenia can increase the risk of infections and other complications, highlighting the importance of maintaining a balanced level of PMNs in the body.