From the Guidelines
An elevated Complete Blood Count (CBC) with increased neutrophils, lymphocytes, and monocytes is a significant finding that suggests an active immune response, most commonly due to infection, and requires prompt medical evaluation. This finding can be associated with various conditions, including bacterial or viral infections, inflammation, or other underlying causes 1. The increase in neutrophils, lymphocytes, and monocytes indicates that the body is responding to an infection or inflammation, with neutrophils primarily combating bacterial infections, lymphocytes responding to viral infections and regulating immunity, and monocytes helping with inflammation and tissue repair.
Some possible causes of an elevated CBC with increased neutrophils, lymphocytes, and monocytes include:
- Bacterial infections, such as Shigellosis, which can be associated with a leukemoid reaction 1
- Viral infections, which can cause a lymphocytic predominance 1
- Intracellular pathogens, such as Salmonella, which can cause a monocyte predominance 1
- Other conditions, such as inflammation, certain medications, stress, or less commonly, blood disorders or malignancies
It is essential to consult with a healthcare provider promptly for proper evaluation and interpretation of the CBC results in the context of symptoms and medical history 1. The healthcare provider will likely perform additional tests to determine the underlying cause and develop an appropriate treatment plan. Treatment depends entirely on the diagnosis, and bacterial infections may require antibiotics, while viral infections often resolve with supportive care 1.
From the Research
Significance of Elevated Complete Blood Count (CBC) with Increased Neutrophils, Lymphocytes, and Monocytes
- An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with poor outcomes in various medical conditions, including stroke 2, COVID-19 3, Hodgkin lymphoma 4, multiple myeloma 5, and medical inpatients with multiple chronic conditions 6.
- Increased neutrophils and decreased lymphocytes have been linked to inflammation and poor prognosis in these conditions.
- The monocyte-to-lymphocyte ratio (MLR) has also been shown to be a predictor of poor prognosis in multiple myeloma 5.
- Elevated NLR and MLR, and decreased platelet-to-lymphocyte ratio (PLR) have been associated with unfavorable clinicobiological features and poor survival in multiple myeloma 5.
- An elevated NLR > 3.0 at admission and discharge has been independently associated with mortality in medical inpatients with multiple chronic conditions 6.
Association with Specific Medical Conditions
- In stroke patients, an elevated NLR (> 6.03) has been shown to predict in-hospital mortality 2.
- In COVID-19 patients, decreased lymphocyte percentages and increased neutrophils have been associated with poor outcomes 3.
- In Hodgkin lymphoma patients, elevated NLR and decreased LMR have been linked to poor prognosis 4.
- In multiple myeloma patients, elevated NLR, MLR, and decreased PLR have been associated with poor survival 5.
- In medical inpatients with multiple chronic conditions, elevated NLR has been associated with mortality and increased risk of re-admissions 6.