From the Guidelines
The management of a leukemoid reaction focuses primarily on treating the underlying cause rather than the elevated white blood cell count itself. The first step is to identify and address the triggering condition, which may include severe infections, malignancies, severe hemorrhage, or certain medications. No specific medication is required to directly treat the leukemoid reaction, as it is a reactive process that will resolve once the underlying cause is controlled. During management, supportive care should be provided while diagnostic workup continues, including complete blood count monitoring, peripheral blood smear examination, and appropriate imaging or cultures to identify the source. It's essential to distinguish a leukemoid reaction from true leukemia, which may require bone marrow examination in unclear cases, as noted in studies such as 1. Hydration and symptomatic management may be necessary depending on the patient's clinical status. The prognosis for leukemoid reaction depends entirely on the underlying cause, with complete resolution of the elevated white blood cell count expected once the primary condition is successfully treated. This reactive process represents the bone marrow's normal physiologic response to stress or inflammation, resulting in increased production and release of white blood cells, particularly neutrophils. In cases where the leukemoid reaction is suspected to be related to a specific condition like acute promyelocytic leukemia (APL), guidelines from expert panels such as the European LeukemiaNet 1 provide recommendations for diagnosis, treatment, and follow-up, emphasizing the importance of rapid diagnosis and appropriate management to prevent complications. However, for a leukemoid reaction itself, the approach remains focused on the underlying cause rather than the leukocytosis, with supportive care and monitoring being key components of management, as indirectly supported by the principles outlined in various leukemia management guidelines 1.
From the Research
Management of Leukemoid Reaction
The management of a leukemoid reaction is primarily focused on treating the underlying cause of the reaction.
- The prognosis of patients with leukemoid reaction depends mainly on their underlying illness 2.
- Infection is the most common cause of leukemoid reaction, followed by ischemia/stress, inflammation, and obstetric diagnoses 2.
- Antibiotics were prescribed for 80.9% of patients with leukemoid reaction, indicating that infection is a major cause of this condition 2.
- The diagnostic work-up for leukemoid reaction consists of the exclusion of chronic myelogenous leukemia (CML) and chronic neutrophilic leukemia (CNL) and the detection of an underlying cause 3.
- Severe infections, intoxications, malignancies, severe hemorrhage, or acute hemolysis are major causes of leukemoid reactions 3.
- Leukemoid reaction can also be caused by granulocyte colony-stimulating factor producing tumors, such as urothelial carcinoma of the renal pelvis 4.
- Treatment of the underlying cause can lead to resolution of the leukemoid reaction, as seen in a case of mesenteric inflammatory pseudotumor where surgical resection led to resolution of the leukemoid reaction 5.
- Factors found to be highly correlated with death in patients with leukemoid reaction include age, any infectious diagnosis, and sepsis 2.
- A study found that lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death in patients with leukemoid reaction 6.