Protocolo diagnóstico de las leucocitosis afebriles

Abstract

Leukocytosis, defined as an increase in the white blood cell count, can occur in a multitude of clinical situations. This protocol will focus on afebrile leukocytosis. To assess leukocytosis, the type of cell with increased values, the degree of leukocytosis, and the patient's symptoms must be evaluated and the morphology of cells observed under the microscope must be taken into account.

Neutrophilia refers to an increase of at least two standard deviations above the mean in the number of neutrophils in peripheral blood. The most frequent causes of neutrophilia are reactive forms (secondary to another condition) and the other group are those of primary origin when there is autonomous medullary hyperproduction.

Lymphocytosis is defined as an absolute lymphocyte count greater than 4000/μl, although up to 8000/μl may be normal in newborns and children. Reactive causes are more common in children or young adults, notable among which are mononucleosis syndromes. Other important causes are those secondary to clonal disorders; therefore, a blood smear study for cell morphology and flow cytometry study are required.

Monocytosis is defined as an increase in the number of monocytes in peripheral blood above 1000/μl. The most frequent causes are infections. Other important causes to consider, especially if monocytosis is sustained and secondary causes have been ruled out, are primary hematologic malignancies, especially in older adults or in patients with unexplained cytopenias.