Leucocytosis

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Leucocyte count of more than 11X109/L.

Causes vary widely, from a normal response to an acute infection through to a haematological neoplastic process.

Causes

  • Acute inflammatory response
  • Drugs: steroids, GCSF therapy
  • Smoking
  • Solid tumours
  • Haematological disorders: AML, CML, CLL, CMML, MPN

Assessment

  • History and careful assessment for reactive causes, including drug and smoking history.
  • Careful examination for adenopathy, organomegaly
  • Repeat FBC, differential white cell count and blood film examination
  • CRP, liver and renal profile
  • Urinalysis
  • Consider Chest X-Ray particularly in smokers or cases with chest symptoms

Who to refer

Cases that should be referred immediately for management

  • Suspected acute Leukaemia. The on-call haematologist will contact the primary care after reviewing the blood results and blood film from the sample obtained
  • New cases of CML presenting with high white cell count (>100) or symptoms suspicious of hyperviscosity (visual blurring / loss, persistent headache, thrombosis)
  • New cases of CLL presenting with features of active haemolysis or severe cytopenia

Urgent referral

  • Unexplained persistent leucocytosis; leucocytes >50
  • New cases of CML excluding those with the above features
  • New cases of CLL with bulky adenopathy or B-symptoms ( drenching night sweats, weight loss of >10% of body weight in 3 months, excess fatigue)
  • Unexplained leuco-erythroblastic peripheral blood film; the film will be reported and phoned to the referring practice.

Routine referral

  • Persistent leucocytosis of > 20
  • Monocytosis
  • Basophilia

Editorial Information

Last reviewed: 01/10/2024

Next review date: 01/10/2026

Author(s): Muayed Lasebai, Ranjit Thomas, Paul Ames.

Version: 1.0