What is the appropriate management for a patient with leukocytosis characterized by neutrophilia and monocytosis?

From the Guidelines

The appropriate management for a patient with leukocytosis characterized by neutrophilia and monocytosis involves a comprehensive workup to identify the underlying cause, followed by targeted treatment, which may include antimicrobial therapy, anti-inflammatory medications, or specific chemotherapy regimens, as indicated by the patient's clinical presentation and diagnostic findings. The patient's laboratory results show a white blood cell count of 16.0 thousand/uL, which is elevated, with an absolute neutrophil count of 11,296 cells/uL and an absolute monocyte count of 1,296 cells/uL, indicating neutrophilia and monocytosis. Given the potential risks associated with neutropenia, as highlighted in the study by 1, it is crucial to identify and manage any underlying infections promptly. Key steps in the management include:

• Initial evaluation with a complete blood count with differential, peripheral blood smear, basic metabolic panel, and inflammatory markers
• Investigation for infectious causes with cultures and imaging studies
• Targeted antimicrobial therapy based on pathogen and sensitivity results
• Consideration of anti-inflammatory medications for non-infectious inflammatory conditions
• Bone marrow aspiration and biopsy, along with flow cytometry, cytogenetic analysis, and molecular studies if hematologic malignancy is suspected Regular monitoring of complete blood counts is essential to assess response to treatment, as the approach must be individualized based on the patient's clinical presentation. The study by 1 emphasizes the importance of preventing and managing febrile neutropenia, which can have significant complications and mortality, highlighting the need for prompt and effective management of patients with abnormal white blood cell counts.

From the Research

Leukocytosis Characterized by Neutrophilia and Monocytosis

• The patient's laboratory results show an elevated white blood cell count (16.0 Thousand/uL) with neutrophilia (70.6% and 11,296 cells/uL) and monocytosis (8.1% and 1,296 cells/uL) 2, 3.
• These findings suggest a potential infection or inflammatory process, which is a common cause of leukocytosis 2, 3.
• The patient's monocyte count is also elevated, which may be associated with certain infections, allergic reactions, or other causes 3.

Clinical Assessment and Management

• A repeat complete blood count with peripheral smear may provide helpful information, such as types and maturity of white blood cells, uniformity of white blood cells, and toxic granulations 2.
• The patient's clinical presentation, including symptoms such as fever, weight loss, bruising, or fatigue, should be evaluated to determine the underlying cause of the leukocytosis 2, 3.
• If malignancy cannot be excluded or another more likely cause is not suspected, referral to a hematologist/oncologist is indicated 2.
• The association between white blood cell counts, including neutrophils and monocytes, and the presence, severity, and types of carotid atherosclerotic plaque has been reported in some studies 4.

Diagnostic Techniques

• Treatment of blood smears with Wright's stain is a helpful tool in detecting white blood cell abnormalities, but automated evaluations of unlabeled blood smears using techniques such as phase imaging with computational specificity (PICS) are being developed 5.
• PICS uses color spatial light interference microscopy (cSLIM) and deep learning tools to localize, classify, and segment white blood cells in blood smears, providing quantitative clinical information 5.