From the Research
The workup for neutrophilia with a WBC of 26,000/μL and ANC of 23,000/μL should begin with a thorough history and physical examination to identify potential causes, as recommended by 1 and 2. The initial step in evaluating neutrophilia is to determine if the elevation in white blood cell count is due to a benign or malignant cause.
- A thorough history and physical examination are crucial to identify potential causes of neutrophilia, such as infections, inflammatory conditions, or medications.
- Initial laboratory tests should include a complete blood count with differential, peripheral blood smear, comprehensive metabolic panel, and inflammatory markers like C-reactive protein and erythrocyte sedimentation rate, as suggested by 1.
- Common causes to investigate include infections (bacterial, fungal, or parasitic), inflammatory conditions, medications (corticosteroids, lithium), malignancies (particularly leukemia), and physiologic stress.
- If no obvious cause is found, bone marrow examination may be necessary to rule out myeloproliferative disorders, as recommended by 2.
- Treatment depends on the underlying cause - antibiotics for infections, discontinuation of offending medications, or specific therapy for identified malignancies.
- For primary hematologic disorders like chronic myeloid leukemia, referral to a hematologist is essential for specialized treatment, as suggested by 1 and 2.
- Symptomatic management may include hydration and pain control while the underlying cause is being addressed.
- The urgency of workup depends on the patient's clinical status, with more rapid evaluation needed for those with fever, signs of infection, or other concerning symptoms, as recommended by 1 and 2. However, the most recent study 3 suggests that empiric antibiotic treatment with cefepime may be associated with a delay in achieving clinical stability compared to meropenem, highlighting the importance of selecting the appropriate antibiotic based on the suspected cause of infection. In this case, since the evidence from 1, 2 is more directly relevant to the workup and treatment of neutrophilia, the recommendation is to follow the approach outlined in these studies.