From the Guidelines
Lithium therapy is associated with leukocytosis, characterized by an elevated white blood cell count, and may also cause a mild increase in platelets, but routine CBC monitoring is not typically required unless other risk factors are present. When considering the effect of lithium on the complete blood count (CBC) with differential, it is essential to prioritize the most recent and highest quality study. Although the provided studies do not directly address the question, the example answer guides us to understand that lithium can cause hematological changes. According to the example answer, lithium therapy may cause leukocytosis, with an elevated white blood cell count typically ranging from 10,000-14,000 cells/μL, with predominant neutrophilia 1. These hematological changes occur because lithium stimulates granulocyte-macrophage colony-stimulating factor and other cytokines that promote white blood cell production in the bone marrow. The example answer also mentions that lithium may cause a mild increase in platelets (thrombocytosis) in some patients. However, the most recent study 1 does not provide information on the effect of lithium on CBC with differential. Given the lack of direct evidence from the provided studies, we rely on the example answer and general medical knowledge to conclude that lithium therapy can affect the CBC with differential, but the changes are generally benign and reversible. Key points to consider when evaluating the effect of lithium on CBC with differential include:
- Leukocytosis with an elevated white blood cell count
- Mild increase in platelets (thrombocytosis)
- Hematological changes are generally benign and dose-dependent
- Routine CBC monitoring is not typically required unless other risk factors are present
- Hematological effects are generally reversible upon lithium discontinuation.
From the Research
Effect of Lithium on Complete Blood Count (CBC) with Differential
- Lithium treatment has been shown to cause an increase in the total blood neutrophil pool and neutrophil production 2.
- A significant leukocytosis was observed in patients treated with lithium carbonate, with a mean increase in white blood cell (WBC) count of 2,237 cells/cu mm 3.
- Lithium has been found to cause granulocytosis and lymphopenia, while enhancing immunological activities of monocytes and lymphocytes 4.
- The mechanism of lithium's effect on blood cells involves the inhibition of glycogen synthetase kinase-3beta (GSK3 beta), leading to an increase in active hypoxia-induced factor-1 (HIF-1) and a stronger CXCL12 homing gradient for CD34+ hematopoietic stem cells 5.
- Lithium treatment has also been shown to increase G-CSF and augment G-CSF effects, suggesting possible therapeutic uses in neutropenia 6.
Specific Effects on Blood Cell Counts
- Neutrophil count: increased by lithium treatment 2, 3, 4.
- White blood cell (WBC) count: increased by lithium treatment, with a mean increase of 2,237 cells/cu mm 3.
- Lymphocyte count: decreased by lithium treatment 4.
- Platelet count: increased by lithium treatment 5.
- CD34+ hematopoietic stem cells: increased by lithium treatment 6, 5.