From the Guidelines
Prednisone can increase white blood cell (WBC) counts, particularly neutrophils, through several mechanisms, and its effects on WBC counts are well-documented in the context of treating various conditions, including immune thrombocytopenia 1. When administered, prednisone typically causes a rise in WBC counts within 4-6 hours, with effects lasting as long as the medication is continued. The standard dosing varies based on the condition being treated, ranging from 5-60 mg daily, with higher doses used for acute inflammatory conditions and lower doses for chronic management. Some key points to consider when using prednisone to increase WBC counts include:
- The medication mobilizes neutrophils from the marginated pool into circulation, delays their migration out of blood vessels, and stimulates the bone marrow to release stored neutrophils 1.
- Prednisone reduces neutrophil adhesion to vessel walls and inhibits their movement into tissues, which can be beneficial in treating certain autoimmune disorders or inflammatory conditions 1.
- While prednisone increases circulating WBCs, it actually suppresses immune function overall, so the elevated count doesn't necessarily indicate improved immune defense 1. It's essential to weigh the benefits and risks of prednisone therapy, considering its potential to increase WBC counts while also suppressing immune function and potentially causing other adverse effects, such as osteoporosis, myopathy, and psychologic effects 1.
From the Research
Increase in WBC Count due to Prednisone
- The administration of prednisone, a type of corticosteroid, is known to cause an increase in white blood cell (WBC) count, a phenomenon referred to as leukocytosis 2, 3, 4.
- Studies have shown that the degree of leukocytosis is related to the dosage of prednisone administered, with higher doses resulting in greater increases in WBC count 2, 4.
- The increase in WBC count is attributed predominantly to a rise in polymorphonuclear white blood cells, accompanied by monocytosis, eosinopenia, and a variable degree of lymphopenia 4.
- The effects of glucocorticoids, such as prednisone, on leukocytes are mediated by genomic and non-genomic mechanisms, involving the regulation of proliferation, differentiation, and apoptosis of white blood cells 5.
Clinical Implications
- Clinicians should be cautious when interpreting WBC counts in patients on prednisone therapy, as increases in WBC count may be due to the steroid effect rather than infection 2, 3, 5.
- A shift to the left in the peripheral white blood cells, i.e., more than 6 percent band forms, and the appearance of toxic granulation may assist in the differential diagnosis between infection and corticosteroid-induced leukocytosis 4.
- The monitoring and management of complications associated with systemic corticosteroid therapy, including osteoporosis, adrenal suppression, and immunosuppression, are crucial to minimize the risks of treatment 6.