What is the significance of neutrophil-predominant leukocytosis (elevated white blood cell count) with increased monocytes?

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Last updated: February 18, 2025View editorial policy

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Differential Diagnosis for Neutrophil Predominant Leukocytosis with Monocytes

  • Single Most Likely Diagnosis
    • Bacterial infection (e.g., pneumonia, sepsis): This is the most common cause of neutrophil predominant leukocytosis, and the presence of monocytes may indicate a chronic or severe infection.
  • Other Likely Diagnoses
    • Acute stress reaction (e.g., post-surgery, trauma): Stress can cause demargination of neutrophils and an increase in monocytes.
    • Inflammatory conditions (e.g., acute appendicitis, cholecystitis): Neutrophil predominant leukocytosis is a common finding in inflammatory conditions, and monocytes may be elevated in response to tissue damage.
    • Chronic myeloid leukemia (CML): Although less common, CML can present with neutrophil predominant leukocytosis and an increase in monocytes.
  • Do Not Miss Diagnoses
    • Sepsis with a fungal or parasitic infection: These infections can present with neutrophil predominant leukocytosis and monocytes, and are often life-threatening if not promptly treated.
    • Hematologic malignancy (e.g., acute myeloid leukemia, myeloproliferative neoplasm): Although less common, these conditions can present with neutrophil predominant leukocytosis and monocytes, and are often aggressive and life-threatening.
  • Rare Diagnoses
    • Myeloproliferative neoplasm (e.g., polycythemia vera, essential thrombocytosis): These conditions can present with neutrophil predominant leukocytosis and monocytes, but are relatively rare.
    • Chronic neutrophilic leukemia: A rare condition characterized by persistent neutrophilic leukocytosis, often with an increase in monocytes.
    • Leukemoid reaction: A rare condition characterized by a marked increase in neutrophils and monocytes, often in response to a severe infection or inflammatory condition.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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