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Leukemoid Reaction and Diagnosis (D/D from Chronic Myelocytic leukemia)

Leukemoid Reaction and Diagnosis (D/D from Chronic Myelocytic leukemia)
April 30, 2022HematologyLab Tests

Leukemoid Reaction

Sample blood for leukemoid reaction

  • Blood in EDTA is needed, along with a fresh blood smear.

Definition of Leukemoid Reaction

  1. If there is a persistent increase in the neutrophils, reactive and excessive leucocytosis with a count of 30,000 to 50,000 / µL, with immature and mature white cells in the peripheral blood smear is called Leukemoid reaction. Sometimes lymphocytic reactions may be seen.
  2. This is not a primary marrow disorder, and this is due to secondary infections.
  3.   The count varies from 50,000 to 100,000/cmm. with the presence of immature cells.
  4. Blast cells in the peripheral blood smears are not seen, which helps differentiate from leukemia.
  5. Extremely elevated counts >100,000/cmm are more suggestive of the myeloproliferative process, with some exceptions.

Types of leukemoid reaction:

  1. Neutrophilic reaction.
  2. Lymphocytic reaction.
  3. Monocytic reaction.

Significance of leukemoid reaction

  1. This term is used to differentiate between leucocytosis and leukemia.
  2. In leukocytosis or neutrophilia, there is an increase in the count from 10,000 to 25,000 / µL (microliter).

Pathogenesis of leukemoid reaction:

  1. Leucocytosis results from the release of the cells from the bone marrow under the influence of IL-1 and TNF.
  2. There is a shift to the left of the neutrophils.
  3. Prolonged infection induces in the bone marrow the proliferation of the precursor cells, and that is also produced by the cytokines like  IL-1 and TNF.
  4. Bacterial infections induce a selective increase in the neutrophils, while parasitic infestation induces eosinophilia.
  5. Mumps, Rubella, and some viruses lead to a selective increase in the lymphocytes and cause lymphocytosis.

The differentiating point from leukemia:

  1.  In the leukemoid reaction, the neutrophils are mature and not clonally derived.
  2. There is a persistent increase in TLC above 50,000/cmm and no evidence of leukemia.
  3. Blood count comes to normal after treating the cause.
  4. Increased blast cells are not seen in the leukemoid reaction.
  5. A count above 100,000 /µL is more suggestive of the myeloproliferative disorder with very few exceptions.
  6. Granulocytes show toxic granulations and Dohle bodies.
  7. NAP score is high, which is low in leukemia.
  8. Leukemoid reaction shows:
    1. Toxic granulations.
Leukemoid reaction, toxic granules

Leukemoid reaction, toxic granules

    1. Toxic vacuolization.
    2. Presence of Dohle bodies. These are light blue to grey, oval, and basophilic inclusions in the neutrophils. Usually seen in the peripheral area of the cytoplasm of neutrophils. These consist of ribosomes and endoplasmic reticulum.
Leukemoid reaction Dohle bodies

Leukemoid reaction Dohle bodies

Leukemoid reaction, leucocytosis

Leukemoid reaction, leucocytosis

Leukemoid reaction parameters

Leukemoid reaction parameters

Differential diagnosis includes:

  1. Chronic myeloid leukemia.

Causes of Leukemoid reaction (Neutrophilic type):

  1. A severe infection:
    1. Septicemia.
    2. Clostridium.
    3. Tuberculosis.
    4. Pertussis.
    5. Infectious mononucleosis.
    6. Endocarditis.
    7. Pneumonia.
    8. Tuberculosis.
  2. Toxic conditions:
    1. Eclampsia.
    2. Burns.
    3. Mercury poisoning.
  3. Parasitic infestation:
    1. Larval migration leads to eosinophilia.
  4. Leukemoid lymphocytosis:
    1. It is seen in Tuberculosis, Whooping cough, and infectious mononucleosis.
  5. Malignancy:
    1. Carcinoma of the colon.
    2. Embryonal carcinoma of kidneys.
  6. Miscellaneous causes:
    1. Severe hemorrhage.
    2. Acute hemolysis.
    3. Diabetic ketoacidosis.
    4. Ischemic colitis.
    5. Hepatic necrosis.
  7. Drugs:
    1. Like Sulfa, Dapsone, Glucocorticoids, and the G-CSF factor.

Lymphocytic leukemoid reaction is seen in:

  1. Infections:
  2. Infectious mononucleosis.
  3. Pertussis.
  4. Varicella.
  5. Tuberculosis.
  6. Malignancies:
    1. Carcinoma of the stomach.
    2. Carcinoma of the breast.
  7. Others like Dermatitis herpetiformis.

Monocytic leukemoid reaction:

  1. It is seen in tuberculosis.

Difference between Leukemoid reaction and chronic myelocytic leukemia:

Clinical parameters Leukemoid reaction Chronic myeloid leukemia
What is the basis physiological process pathological process
WBC count usually <50,000/cmm ( rarely > 60 x 109/L) usually >50,000/cmm (50 to 500 x 109/L)
Basophils absent usually increased count
platelets normal Increased
Eosinophil normal Increased
Hemoglobin usually normal usually low
Band form these are prominent  all stages (myelocytes)
Toxic granules and Dohle bodies these are present toxic granules ± to 0
Spleen usually not present usually enlarged
Philadelphia chromosome absent present in 90% of the cases
Leucocytes Alk. phosphatase (LAP) score normal or increased > 100 < 10 (Decreased)
History short long
After the treatment Count becomes normal This may be still raised
Question 1: What is the difference between leukemoid reaction and leukemia.
Show answer
Leukemoid reaction show signs of immaturity, but Laking blast cells. The count is usually between 50,000 to 100,000/cmm. Alkaline phosphatase score is usually increased while it is decreased in leukemia.
Question 2: What are the types of leukemoid reaction.
Show answer
These are three types according to the type of cells. So leukemoid reaction may be neutrophilic, lymphocytic or monocytic.

Possible References Used
Go Back to Hematology

Comments

Temika Fauber Reply
September 5, 2020

I agree with you

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