From the Guidelines
Prednisone commonly causes elevated neutrophil counts (neutrophilia) as a normal side effect, and this elevation is typically temporary and resolves when the medication is discontinued. This occurs because prednisone, a corticosteroid medication, prevents neutrophils from leaving the bloodstream and moving into tissues, while also stimulating the release of neutrophils from bone marrow storage pools. Additionally, prednisone reduces neutrophil cell death (apoptosis), further increasing their numbers in circulation. The neutrophil count may rise within hours of taking prednisone and can increase by 30-50% above baseline levels. This effect is dose-dependent, with higher doses causing more significant elevations.
Key Points to Consider
- If you're taking prednisone and notice elevated neutrophils on your blood work, this is generally not a cause for concern unless the elevation is extreme or accompanied by symptoms of infection.
- Your healthcare provider should be monitoring your blood counts while you're on prednisone therapy, especially during long-term treatment.
- Never stop taking prednisone suddenly without medical guidance, as this can lead to withdrawal symptoms.
- The risk of infection is elevated in patients with cancer, who may experience immunosuppression resulting from cancer treatment and sometimes from the disease itself, and chemotherapy can cause neutropenia, which is a major risk factor for the development of infections 1.
- The frequency and severity of infection are inversely proportional to the neutrophil count, with the risks of severe infection and bloodstream infection greatest (approximately 10%–20%) at neutrophil counts below 100 cells/mcL 1.
Monitoring and Management
- Regular monitoring of blood counts is essential for patients on prednisone therapy, especially during long-term treatment.
- Patients should be aware of the signs and symptoms of infection and seek medical attention if they experience any unusual symptoms.
- Healthcare providers should be cautious when prescribing prednisone to patients with a history of infections or immunosuppression, and consider alternative treatments or closer monitoring as needed.
From the Research
Elevated Neutrophils due to Prednisone
- Elevated neutrophil counts have been observed in patients taking prednisone, as seen in a study where a single dose of prednisone resulted in a mean rise in neutrophil counts to 2.3 times the initial value 2.
- The increase in neutrophil count is thought to be due to a reduction in the egress of neutrophils to the tissues and a decrease in the neutrophil turnover rate, as suggested by a study that found a decrease in plasma lysozyme levels after prednisone administration 2.
- However, another study found that the observed neutrophilia in patients using glucocorticoids may be associated with underlying disease rather than glucocorticoid use itself, as no increase in neutrophil count was found in glucocorticoid users within diagnostic subgroups 3.
- A more recent study found that prednisone use was associated with increased leukocyte and neutrophil counts in patients with community-acquired pneumonia, with a mean difference of 27% for leukocytes and 33% for neutrophils 4.
- The mechanisms of action of glucocorticosteroids, including prednisone, involve impeding the access of neutrophils and monocytes to an inflammatory site, causing neutrophilic leukocytosis, and affecting lymphocyte function 5.
Clinical Considerations
- Patients receiving chronic steroids, including prednisone, have an increased susceptibility to various infections, with the risk of infection related to the dose and duration of therapy 6.
- Clinicians should consider both common and unusual opportunistic infections in patients receiving chronic steroids, and adjust the corticosteroid regimen to attain maximal therapeutic benefit with minimal adverse side effects 6, 5.