- Blood in EDTA is needed along with fresh blood smear.
- If there is a persistent increase in the neutrophils with a count of 30,000 to 50,000 / µL, with the presence of immature and mature white cells is called Leukemoid reaction.
- This is not primary marrow disorder, is secondary to infections.
- This term is used to differentiate between the leucocytosis and leukemia.
- In leukocytosis or neutrophilia there is an increase in the count from 10,000 to 25,000 / µL (microliter).
The differentiating point from leukemia
- In the leukemoid reaction, the neutrophils are mature and not clonally derived.
- There is a persistent increase in TLC above 50,000/cmm and no evidence of leukemia.
- Blood count comes to normal after treating the cause.
- Increased blast cells are not seen in the leukemoid reaction.
- A count above 100,000 /µL is more suggestive of the myeloproliferative disorder with very few exceptions.
Differential diagnosis includes:
- Chronic myeloid leukemia.
Causes of Leukemoid reaction:
- Severe infection like Clostridium, Tuberculosis, Pertussis and Infectious mononucleosis.
- Visceral larva migration leads to eosinophilia.
- Tuberculosis gives rise monocytosis.
- Leukemoid lymphocytosis is seen in Tuberculosis, Whooping cough and infectious mononucleosis.
- Severe hemorrhage.
- Acute hemolysis.
- Drugs like Sulfa, Dapsone, Glucocorticoids, and use of G-CSF factor.
- Diabetic ketoacidosis.
- Ischemic colitis.
- Hepatic necrosis.
Difference between Leukemoid reaction and chronic myelocytic leukemia
||Chronic myeloid leukemia
||usually increased count
||these are prominent
|| all stages (myelocytes)
|Toxic granules and Dohle bodies
||these are present
||toxic granules ± to 0
||usually not present
||present in 90% of the cases
|Leucocytes Alk.phosphatase (LAP)
Possible References Used
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