WBC – too high or too low?

23 Oct
WBC TOO HIGH (Hyperleukocytosis):
  • WBC > 50k (often >100k)
  • usually with AML or CML with blast crisis
  • symptoms usually pulm or neuro – due to white cells plugging microvasculature and/or tissue hypoxemia with cytokine damage
  • call oncology (need chemo or leukopheresis)
  • IV fluids
  • antibiotics
  • only chemo improves mortality
WBC TOO LOW (neutropenia):
  • fever is sometimes the earliest/only symptoms (due to muted inflamm response)
  • neutropenia = ANC < 1500 cells/uL
  • severe neutropenia = ANC < 500
ANC = WBC count X (%PMNs + %Bands)
  • IV antibiotics
  • IV Fluids
  • pan infectious workup (blood cx’s, urine, etc)


SLIGHT TANGENT, since we’re talking about low immune response…
10 second version:
absolute lymphocyte count = ALC 
ALC < 2500 (95% sensitive for CD4 <200)
ALC < 800 (91% specific for CD4 <200)
 There you go.  

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