From the Guidelines
Hypoglycemia can indeed cause leukocytosis, as the body's stress response to low blood sugar triggers the release of counter-regulatory hormones that stimulate the bone marrow to release white blood cells into circulation. When blood sugar levels drop significantly, the body responds with a stress reaction that triggers the release of counter-regulatory hormones such as epinephrine, cortisol, and growth hormone 1. These hormones not only work to increase blood glucose levels but also stimulate the bone marrow to release white blood cells into circulation, resulting in leukocytosis. This physiological stress response is similar to what occurs during other acute stressors like infection, trauma, or intense exercise. The leukocytosis associated with hypoglycemia is typically transient and resolves once blood glucose levels are normalized.
Some key points to consider in the context of hypoglycemia and leukocytosis include:
- The degree of white blood cell elevation generally correlates with the severity of the hypoglycemic episode, with more profound drops in blood sugar potentially causing more significant leukocytosis 1.
- Hypoglycemia is a common issue in hospitalized patients, particularly the elderly, and is associated with poor outcomes, including increased mortality 1.
- The presence of certain conditions, such as renal failure, sepsis, and low albumin level, can increase the risk of hypoglycemia in hospitalized patients 1.
- It is essential to recognize the relationship between hypoglycemia and leukocytosis in clinical settings, as leukocytosis discovered during a hypoglycemic episode should not automatically be attributed to infection or other inflammatory conditions without considering the contribution of low blood sugar to the elevated white cell count.
In terms of managing hypoglycemia and preventing leukocytosis, the following strategies can be employed:
- Glucose (15–20 g) is the preferred treatment for the conscious individual with hypoglycemia, although any form of carbohydrate that contains glucose may be used 1.
- Glucagon should be prescribed for all individuals at significant risk of severe hypoglycemia, and caregivers or family members of these individuals should be instructed on its administration 1.
- Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition and/or declining cognition is found 1.
From the Research
Hypoglycemia and Leukocytosis
- Hypoglycemia, or low blood sugar, can be related to leukocytosis, or elevated white blood cell count, in certain contexts.
- Studies have shown that high levels of leukocytes can consume glucose in vitro, leading to factitious hypoglycemia 2, 3.
- This phenomenon is particularly relevant in patients with leukemia or other conditions characterized by high leukocyte counts.
- The relationship between hypoglycemia and leukocytosis is primarily artifactual, resulting from glucose consumption by leukocytes between the time of sampling and laboratory analysis 3.
- There is no direct evidence to suggest that hypoglycemia causes leukocytosis, but rather that leukocytosis can lead to artifactual hypoglycemia due to in vitro glucose consumption.
Clinical Implications
- Clinicians should be aware of the potential for factitious hypoglycemia in patients with high leukocyte counts, and consider this when interpreting blood glucose results 2, 3.
- Effective communication between biologists and clinicians is essential for identifying and addressing this phenomenon 3.
- The use of glycolysis inhibitors can help prevent factitious hypoglycemia, but may interfere with other laboratory measurements 2.
Relevant Studies
- A 1983 study found that in vitro glucose consumption is linked to the intensity of leukocyte concentration, and is independent of the type of leukocyte 2.
- A 2010 case report described a patient with lung cancer and hyperleukocytosis who experienced factitious hypoglycemia due to glucose consumption by leukocytes 3.