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neutrophilia

neutrophilia (high WCC)

see also:

  • remember age-specific reference ranges!
  • total WBC and neutrophil count in neonates younger than 1 week are physiologically higher than those of older children and adults
  • infants < 3 months old have small pool of neutrophils and thus often present with neutropenia in response to bacterial infections
  • a very high WCC (hyperleukocytosis) may be due to leukaemia, etc

introduction

  • a raised white cell count (leukocytosis) with neutrophilia is one of the most common investigation results searched for by ED doctors as an inflammatory marker suggestive of bacterial infection, yet this test is so difficult to interpret
  • a normal WCC or even neutropenia may be present even though there is severe sepsis / septicaemia
  • conversely, a raised WCC due to neutrophilia may just be an acute stress response as seen in patients with vomiting, seizure, intense exercise or those taking corticosteroids
  • some patients can be expected to have a persistently raised neutrophil count:
  • a blood film finding of “left shift” is further suggestive of an acute bacterial infective process
  • the utility of this test for many conditions such as appendicitis is further limited in that by the time the patient has a raised WCC, the abdominal findings tend to by highly suggestive anyway, while a normal WCC will not exclude it.
  • nevertheless, in a patient who has no reason to have a raised WCC, if they have presented with abdominal pain and they are found to have a neutrophilia, then it would be prudent to exclude an inflammatory cause and NOT put the pain down to constipation
neutrophilia.txt · Last modified: 2013/08/13 01:10 (external edit)