What Are the Causes of Leukocytosis with Fever?

White blood cells are a general term for a class of cells in the blood, which mainly include monocytes, lymphocytes, and neutrophils. The normal value of white blood cells is (4-10) × 10 ⁹ / L. Above this range is called leukocytosis.

Basic Information

English name: Leukocytosis
Visiting department: Internal medicine, emergency department
Common causes: Infections, rheumatic fever diseases, blood diseases, tissue necrosis, acute blood loss and hemolysis, malignant tumors, metabolic disorders, drugs and poisons, etc.

Common symptoms: Different causes, different performance

Causes of leukocytosis

Physiological factor

Many physiological factors can cause the total number of white blood cells to increase. For example: strenuous exercise; manual labor; long-term exposure to cold air in winter; white blood cells often increase slightly after a full meal or shower. Increased physiological white blood cell count is also seen during menstruation, ovulation, emotional stress, hunger, hypoglycemia, and so on. However, the increase in the number of physiological white blood cells is temporary, and the removal of the influencing factors quickly returns to normal. It may be that when various physiological factors are stimulated, the catecholamine secretion in the body increases, causing peripheral leukocytes to enter the circulation.

2. Pathological factors

(1) Various infections: can be local or systemic infections. Certain bacterial infections, especially staphylococci, streptococcus, pneumococcus, meningococcal infections, etc .; certain viral infections, such as polio, measles, chickenpox virus, rabies virus infection, etc; Borrelia infection, syphilis, etc .; fungi, such as actinomyces infection.

(2) Non-infectious inflammation: rheumatic diseases such as rheumatic fever, rheumatoid arthritis, especially juvenile, nodular polyarteritis, dermatomyositis, vasculitis, etc., neutrophils can increase, such as co-infection More likely to happen. Other inflammations such as nephritis, pancreatitis, colitis, thyroiditis, etc.

(3) Hematological diseases: chronic myeloproliferative diseases (chronic myelogenous leukemia, true erythrocytosis, idiopathic myeloid metaplasia, primary thrombocytosis), acute myeloid leukemia, acute myelocytic leukemia, multiple Myeloma and other patients have significantly increased white blood cells.

(4) Tissue necrosis: such as severe trauma, surgical trauma, burns, myocardial infarction, pulmonary infarction, acute pancreatitis, etc.

(5) Acute hemorrhage and hemolysis: Leukocytes can be seen when bleeding in the thoracic cavity, abdominal cavity, joint cavity, subarachnoid space and intracranial hemorrhage. Ectopic pregnancy ruptures, liver and spleen rupture, and leukopenia is also obvious. In a large amount of acute hemolysis, the number of white blood cells and neutrophil increase can even reach a leukocyte-like response.

(6) Malignant tumors: Stomach, lung, liver, pancreas, breast, uterus, and kidney cancer often have neutrophils. Lymphomas, especially Hodgkin's lymphomas, can have neutrophils or basophils.

(7) Metabolic disorders: such as thyroid crisis, diabetic acidosis, uremia, etc. can cause neutrophils to increase.

(8) Drugs and poisons: some drugs such as epinephrine, catecholamines, glucocorticoids, lithium salts, etc .; mercury poisoning in chemicals, organophosphorus, etc. can also increase neutrophils.

(9) Others: There is an increase in neutrophils 12 to 36 hours after surgery, the degree of which is proportional to the scope of the operation, the amount of blood loss, and the degree of tissue damage.

Leukopenia clinical manifestations

The etiology is different, with the exception of the common signs of increased leukocyte counts, the clinical manifestations are different.

Leukocytosis test

Medical history

Ask patients if they have chills, chills, fever, joint pain, thyroid pain, abdominal pain, headache, chest pain, anterior cardiac pain, low back pain; dizziness, fatigue, cold sweats; hyperthyroidism, diabetes, chronic nephritis, History of hepatitis; history of poisoning, drugs, food allergies; menstrual abnormalities, onset and exertion, overeating, unclean diet, etc., and history of life in the epidemic area or history of infectious disease and poison exposure, or even working and living environment.

2. Physical examination

Are there changes in body temperature, breathing, and blood pressure? Pale skin, bleeding, skin examination, redness of the tonsils, tenderness and swallowing pain in the thyroid area, lung sounds, heart sounds, liver, gallbladder, kidney, pancreas, and accessory areas. Tenderness, abdominal distension, lymph node and hepatosplenomegaly, joint swelling, etc.

3. Laboratory inspection

The laboratory examination must be summarized and analyzed based on the objective materials learned from the medical history and physical examination, from which the possibility of several diagnoses is proposed, and then the actual examination room examinations are further considered to confirm the diagnosis.

(1) Blood routine: In addition to knowing the total number of white blood cells and the increase in classification, it is necessary to observe the morphological changes of white blood cells, whether there are immature white blood cells, and whether there are other hematological abnormalities.

(2) Bacteriological examination: Before applying antibiotics, blood culture should be performed on suspected sepsis, infective endocarditis, typhoid, etc. Repeat as necessary, or perform bone marrow culture.

(3) Bone marrow examination: It is of great value in the diagnosis of various types of leukemia, multiple myeloma, malignant lymphoma, and bone metastatic cancer.

(4) Determination of neutrophil alkaline phosphatase (NAP) activity: Acute bacterial infections, especially purulent infections, have a significantly increased NAP positive rate and score; viral infections have not increased; in chronic myeloid leukemia , Its NAP activity is significantly reduced or can be completely negative. During leukemia-like reactions, NAP can be significantly increased.

(5) Serum immunological examination: Heterophilic agglutination test, anti-streptolysin "O" test, syphilis serum precipitation test, salmonella serum agglutination reaction, virus antibody, antinuclear antibody, rheumatoid factor determination according to the needs of the disease Wait.

(6) Chromosome examination: If Ph chromosome is found, it is helpful for early diagnosis of chronic myelogenous leukemia.

(7) Polymerase chain reaction (PCR): It is of great value in clarifying the etiology of certain diseases, such as genetic tests for hereditary blood diseases, leukemia and lymphoma oncogenes, and pathogenic tests for diseases such as bacterial, tuberculosis, and viral infections. .

(8) Lymph node biopsy: It is of great value for the differentiation of inflammation, tuberculosis and tumor.

4. Image inspection

X-ray fluoroscopy, plain film or radiography, CT, magnetic resonance, ultrasound, etc. are of great value in the diagnosis of the cause.

Leukocytosis diagnosis

The increase in the total number of white blood cells and the classification count is only an abnormal indicator of laboratory tests. It is important to find the cause of the diagnosis of the increase in the total number of white blood cells and the classification count.

Leukocytosis treatment

Treatment of the primary disease causing leukopenia. Those who are caused by the drug should stop using the drug immediately; those who are caused by acute infection or chronic infection should be resistant to infection. Hematocrit caused by blood disease should be actively treated for blood disease.