Can congestive heart failure (CHF) cause leukocytosis?

Can Congestive Heart Failure Cause Leukocytosis?

Yes, congestive heart failure (CHF) can cause leukocytosis, particularly neutrophilia, through inflammatory mechanisms associated with heart failure pathophysiology.

Relationship Between CHF and Leukocytosis

Inflammatory Response in CHF

• CHF is associated with increased production of inflammatory cytokines, primarily TNF-α and IL-6 1
• This inflammatory state can trigger a systemic response that includes leukocytosis
• Neutrophilia (elevated neutrophil count) is the most common form of leukocytosis observed in CHF patients

Evidence Supporting the Connection

• Studies have demonstrated that relative neutrophilia is significantly associated with the development of heart failure, with one study showing an odds ratio of 14.3 (95% CI 5.2-39.3) 2
• Neutrophilic leukocytosis has been documented in patients with dilated cardiomyopathy, especially in cases of compensated heart failure 3
• Elevated differential cell counts, including neutrophil counts, predict future incidence of coronary heart disease and its complications 4

Mechanisms of Leukocytosis in CHF

Pathophysiological Processes

• Inflammation is a key feature in CHF pathophysiology, with activated neutrophils playing a central role 5
• After cardiac injury, neutrophils are essential for initiating inflammation and cardiac repair
• Uncontrolled and prolonged activation of neutrophils can lead to collateral myocardial damage 5
• The neurohumoral activation in CHF contributes to immune-mediated inflammation 3

Other Contributing Factors

• Hemodilution, which commonly occurs in CHF, can affect blood cell counts 1
• Renal dysfunction, often present in CHF patients, can influence inflammatory markers 1
• Medications used to treat CHF may impact white blood cell counts

Clinical Implications

Diagnostic Considerations

• Leukocytosis in CHF patients should prompt evaluation for:

  • Concurrent infections (pneumonia, urinary tract infections)
  • Acute coronary syndromes
  • Pulmonary embolism
  • Other inflammatory conditions

• The European Society of Cardiology lists infections as common precipitating factors for acute decompensated heart failure 1

Prognostic Value

• Leukocytosis has been shown to be an independent predictor of future cardiovascular events 4
• In patients with unstable angina, leukocytosis at initial examination is associated with adverse prognosis, though this association may be confounded by other predictors 6

Management Considerations

• When leukocytosis is present in CHF patients, clinicians should:

  1. Rule out concurrent infections or other inflammatory conditions
  2. Assess for signs of acute decompensation
  3. Continue guideline-directed medical therapy (GDMT) in the absence of hemodynamic instability 1
  4. Consider the impact of inflammation on other aspects of CHF management, such as anemia

• The American College of Cardiology recommends that GDMT be continued in patients with heart failure with reduced ejection fraction (HFrEF) experiencing symptomatic exacerbation requiring hospitalization 1

Conclusion

Leukocytosis, particularly neutrophilia, can occur in CHF due to inflammatory processes inherent to heart failure pathophysiology. While leukocytosis may be a direct result of CHF, clinicians should always consider and rule out other common causes of elevated white blood cell counts in these patients, especially infections which can precipitate heart failure exacerbations.