What is the treatment for leucocytosis?

Treatment of Leukocytosis

The treatment of leukocytosis should be directed at the underlying cause rather than the elevated white blood cell count itself, with specific interventions determined by the etiology, severity, and associated symptoms. 1, 2

Diagnostic Approach

• Leukocytosis is defined as a white blood cell count greater than 11,000/mcL in nonpregnant adults 3
• Common causes include:
  • Infections and inflammatory processes 2
  • Physical or emotional stress 2
  • Medications (corticosteroids, lithium, beta agonists) 2
  • Primary bone marrow disorders (less common but more serious) 2

Management Based on Etiology

Reactive Leukocytosis (Secondary Causes)

• For infection-related leukocytosis:

  • Identify and treat the underlying infection with appropriate antimicrobials 1
  • Blood cultures should be obtained before starting antibiotics in patients with fever 4
  • Leukocytosis typically resolves with successful treatment of the infection 2

• For medication-induced leukocytosis:

  • Consider dose reduction or discontinuation of the offending medication if clinically appropriate 2
  • Common culprits include corticosteroids, lithium, and beta agonists 2

• For inflammatory conditions:

  • Treat the underlying inflammatory disorder (e.g., autoimmune disease, tissue damage) 5
  • Anti-inflammatory medications may be indicated based on the specific condition 1

Hyperleukocytosis (WBC >100,000/μL)

• Represents a medical emergency due to risk of brain infarction and hemorrhage 2
• Immediate aggressive intravenous hydration (2.5-3 liters/m²/day) 1
• Hydroxyurea (50-60 mg/kg/day) to rapidly reduce white blood cell counts 1, 4
• Leukapheresis may be considered in cases of symptomatic leukostasis 1
• Important exception: Avoid leukapheresis in acute promyelocytic leukemia (APL) due to risk of fatal hemorrhage 1, 4

Primary Bone Marrow Disorders

• Acute leukemias:

  • Prompt initiation of definitive therapy is essential 1, 4
  • Patients typically appear ill at presentation 2
  • Urgent referral to a hematology specialist is indicated 3

• Chronic leukemias:

  • Often diagnosed incidentally due to abnormal blood counts 2
  • Treatment according to specific protocols for the type of leukemia 4
  • For chronic myeloid leukemia, induction chemotherapy typically includes an anthracycline and cytarabine 6

• Adult-onset Still's disease:

  • Leucocytosis is common, often with striking neutrophilia 6
  • Treatment directed at the underlying inflammatory condition 6

Special Considerations

• For patients with suspected acute leukemia and hyperleukocytosis:

  • Avoid invasive procedures due to high risk of hemorrhagic complications 4
  • Monitor for tumor lysis syndrome 6
  • Consider rasburicase to prevent hyperuricemia and renal failure in high-risk patients 6

• In chronic myelomonocytic leukemia:

  • Rapidly increasing WBC (>10,000/μL within ≤3 months) may indicate disease progression requiring reassessment 1

Common Pitfalls to Avoid

• Do not automatically attribute persistent leukocytosis to infection without adequate investigation 5
• Avoid prolonged empiric broad-spectrum antibiotics for unexplained leukocytosis without evidence of infection 5
• Do not delay definitive therapy for suspected hematologic malignancies 1, 4
• Recognize that extremely elevated WBC counts or concurrent abnormalities in red blood cell or platelet counts should raise suspicion for primary bone marrow disorders 2