Hyperleukocytosis. Can too high white blood cell counts be dangerous?

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Hyperleukocytosis is the name that should be used to describe the condition of an increased number of white blood cells in a given unit of blood volume, commonly incorrectly called leukocytosis.

A few words about hyperleukocytosis

Leukocytosis is an example of a quantitative reaction. Among the conditions with high white blood cell counts we can mention:

1. reactive (physiological) hyperleukocytosis,
2. proliferative (pathological) hyperleukocytosis.

The term leukocytosis or hyperleukocytosis is an index of quantitative changes and says nothing about the qualitative changes, that is, what are the shifts in the percentage of white blood cells in the peripheral blood. In other words, these terms do not say which cell type dominates the circulating white blood cells in the peripheral blood circulation or proliferation as a result of the observed reaction or proliferation, and which type has decreased its percentage or absolute contribution due to impaired production in the bone marrow.

In connection with the above, we can draw a practical and important conclusion that the assessment of changes in the protein cell system should be based not only on quantitative changes, but (and this is very important) but also on the assessment of qualitative changes, i.e. the dominant cell type in percentage image of peripheral blood.

Reactive hyperleukocytosis

Reactive hyperleukocytosis it is a temporary increase above the physiological limit in the number of white blood cells in a given unit of blood volume. It is considered a desirable reaction in various physiological conditions (e.g. during pregnancy, infants, after physical exertion, weakness), as well as in many diseases:

1. infectious nature,
2. in tissue damage (e.g. heart attack, nephritis, rheumatic fever),
3. metabolic changes (e.g. gout, diabetic acidosis),
4. after medications,
5. after poisoning,
6. and many other.

This increase proves the mobilization of the body’s defense forces in the event of the emergence or a longer-lasting inflammatory-infectious process.

In this light, there is a division into:

1. hyperleukocytosis in physiological states,
2. hyperleukocytosis in pathological conditions, i.e. diseases.

The quantitative limits of this increase vary depending on the reactive capacity of the organism and the intensity and duration of the infection. Qualitative changes are different as they additionally depend on the nature of the infection. In general, the granulocytic system shows greater mobilization in bacterial infections, and the lymphocytic system in viral infections. The doctor can therefore determine the type of infection from the quality of the leukocyte image.

With the cessation or elimination of the cause that stimulates the increased multiplication of white blood cells (and, consequently, hyperleukocytosis), its numerical indicators (both quantitative and qualitative) should return to normal. This phenomenon is also the main factor differentiating reactive from proliferative hyperleukocytosis.

Hypereosinophilia

Hypereosinophilia is a qualitative reaction of the white blood cell system. It is characterized by an increased percentage of eosinophils, often above the normal limit (eosinophilic granulocytes) in the composition of peripheral blood white blood cells, and an increase in their absolute number (in a given unit of blood volume). Many experimental observations and a number of clinical observations show that hypereosinophilia is usually an allergic reaction in the body.

An increased number of eosinophils can be found in the peripheral blood of people with diseases where allergic reactions (e.g. in asthma). In addition, this phenomenon is also very often observed when an organism is infected with parasites, as an expression of its reaction to the appearance of another – parasitic – organism in it.

It is up to the physician to determine the cause and background of hypereosinophilia as well as to select further diagnostic tests and therapeutic management.

Proliferative diseases

Proliferative diseases they are generally characterized by uncontrolled proliferation of the white blood cell system (myeloid or lymphocytic system). They may be the result of the growth of the entire myeloid weave (as in polycythemia vera), or of isolated proliferation of individual cell types.

We can include both in this group bone marrow and leukemic-type lymphatic hyperplastic states, as well as outgrowths originating from the stroma of these tissues, which in only certain periods of their clinical development may manifest themselves in hyperleukocytosis of a specific cell type (retinitis, multiple myeloma, etc.).

Leukemia

The essence of this disease is the inadvertent growth of a specific type of cells of the white blood cell system (bone marrow or lymph nodes) and their subsequent penetration into the blood not only of mature cells, but also of younger cells.

We can distinguish:

1. leukemia originating from the granulocytic system,
2. leukemia originating from the lymphocytic system,
3. leukemia originating from the monocytic system,
4. plasmocytic leukemia and others.

From the point of view of the picture and clinical course, the following can be distinguished:

1. acute leukemia hyperplasia,
2. Chronic leukemic hyperplasia, while the chronic ones may be periodically exacerbated (with exacerbation of disease symptoms).

This exacerbation is usually caused by the rejuvenation of blood cells in the peripheral blood and the appearance of defective young cells.

The cause of leukemia hyperplasia has not been clearly explained so far. It is commonly assumed that four groups of factors are involved in its initiation, namely:

1. genetic predisposition – that is, individual susceptibility and susceptibility,
2. factors of an infectious nature – most likely viral,
3. various physical, chemical or biological factors as cofactors, factors that trigger the proliferation process,
4. impaired function of the immune system.

Factors stimulating the proliferation process cause that in a specific individual, due to genetic predisposition and in the presence of an infectious agent, the biochemistry of the human internal environment is transformed in such a way that the viral factor existing in it (sometimes for years) leads to unrestrained growth of the changed (escaping from serological immune mechanisms) of certain cell types. The immune defense of a specific individual is of great importance here.

If the immune system is healthy and efficient and reacts quickly to the appearance of inappropriate structures (antigens) with the production of antibodies, it prevents the occurrence of any disease symptoms, because it eliminates them already at the stage of formation.

In a situation where the immune system is impaired due to congenital or acquired defects, the action of certain viruses may lead to the formation of new, non-characteristic cell structures. The immunologically impaired organism is unable to quickly and efficiently recognize their antigenic identity and is unable to provide adequate immune defense, which is why it is not able to reject new, pathological, physiologically unsuitable, expanding cell populations.

In these situations, there is an uncontrolled, unintentional, undesirable growth of them.

Due to the excessive development of cells unnecessary for the organism, secondary destruction of other physiological cells of the organism (e.g. red blood cells) occurs with clinical consequences of their increasing deficiency.

The symptoms of leukemia are not the same, because they depend on the type of cells that grow, their maturity and the severity of the disease. It should also be emphasized that, practically speaking, there are no complaints from the patient or family members, or any specific disease symptoms identified by the doctor, which would unambiguously create the basis for the correct diagnosis of leukemia during the first contact with the patient. Most symptoms are non-specific and can be found in many other conditions.

Acute leukemias usually include:

1. rapid development of a serious disease,
2. general weakness (easy fatigue of the patient),
3. septic fever,
4. pale skin (a symptom of anemia accompanying leukemia),
5. symptoms of the angina with gray-brown patches and hard-to-heal ulcers, usually located on the tonsils, oral mucosa and on the tongue,
6. predisposition to the formation of intradermal petechiae, smaller or larger bruises and spontaneous hemorrhages (e.g. from the nose).

Chronic leukemias have similar symptoms but occur less rapidly. Leukemia patients complain of:

1. developing general weakness and limitation of physical fitness,
2. pale skin and conjunctiva as well as visible oral mucosa,
3. sore throat of a variable nature,
4. feeling of pressure in the abdomen,
5. progressive, local or generalized, enlargement of the lymph nodes, etc.,
6. increased predisposition to “catch” infections.

The described symptoms and any lesions should be consulted with a physician in the normal course, i.e. by a local clinic. The doctor, on the basis of the given symptoms and organ changes confirmed by examination, will establish an appropriate diagnostic hypothesis, undertake medical observation and recommend appropriate laboratory tests.

Diagnosis of leukemia

There is no proper medical diagnosis of leukemia, either in terms of clinical type or its cellular type, without examining peripheral blood counts (including platelets and percentage of white blood cells) and bone marrow.

Making a specific diagnosis and selecting the appropriate treatment usually requires hospitalization of the patient. The final diagnosis is established only after a certain period of observation, sometimes only after several complete blood counts of the peripheral blood count, associated with the aforementioned bioptical examination of the bone marrow.

In the event that the above-mentioned changes accompanied by enlargement of the lymph nodes, it is usually necessary to conduct a simultaneous histopathological examination of a specimen of the enlarged lymph node. There is no correct diagnosis of this disease without the combined performance of the above-mentioned and possibly other laboratory and diagnostic tests.

The patient has the right not to consent to a certain examination, but the doctor in such a situation has the right to miss proper diagnosis, and thus appropriate treatment, which is not reasonable from the point of view of the patient’s welfare and to start appropriate treatment as soon as possible.

Treatment

In the case of the discussed states of hyperleukocytosis, treatment is specialized. It aims to inhibit excessive growth and the formation of unnecessary types of cells, and indirectly its negative consequences. Usually, such growth is not indifferent to other organs and the formation of other physiologically necessary cells. Treatment should take place in hospital wards or in specialized hematology and oncology clinics. This type of therapy requires systematic periodic control of complete blood counts, necessary for updating pharmacological preparations and their dosage. The function of other organs often requires pharmacological support as well.

Patients of this type are usually immunocompromised, which increases the risk of various types of infectious complications. To perform control tests or in the period of complications – it is necessary to re-hospitalize the patient. Treatment is difficult and complicated, and its effects sometimes take a long time.

Prevention

In order to prevent the disease, it is important to have a proper diet (healthy eating) and to stay or work in a healthy environment.

Lymphomas

Lymphomas are hyperplastic disease states of the reticuloendothelial component of the hematopoietic system, i.e. the bone marrow, lymph nodes or other foci of lymphoid tissue, dispersed throughout the body, such as in the spleen, tonsils, lymph nodes of the gastrointestinal tract. Occasionally, it may spread to other organs. This group includes clinical varieties that are much more or less diverse in their cell structure.

Diagnosis.

Noticing a fairly pronounced enlargement of the lymph node (or lymph nodes) is an indication (especially in the case of concomitant fever) to see a doctor as soon as possible. Thanks histopathological examination an excision of an enlarged lymph node and a complete blood count, it is possible to establish the correct diagnosis and undertake appropriate treatment.

Early diagnosis of lymphoma and early initiation of systematic treatment treatment with radiant energy or chemotherapeutic drugs practically full recovery. The possibilities of prophylactic counteracting are the same as in other proliferative states of the hematopoietic system.

Multiple myeloma

Multiple myeloma is an increasingly common disease, especially in elderly people. The essence of multiple myeloma is the proliferation of plasma cells, called plasmocytes, which usually grow in the bone marrow in the form of multiple nodular foci, at the same time leading to bone destruction at a given site, up to spontaneous, sometimes difficult to predict, pathological fractures in various places of the bone.

Occasionally, nodular growth of plasmocytes may occur in parenchymal organs (i.e., outside the skeletal system), e.g. in the tonsils, spleen, kidneys.

symptoms.

As in other ailments of hematopoietic system hyperplasia, the onset of the disease is usually not very specific. Patients observe gradually progressive weakness, emaciation and increasing anemia. Later, pains resembling rheumatic pains appear. In addition, there is also a reduced resistance to infections, especially of the respiratory and urinary systems.

Diagnosis

It can be determined by a doctor on the basis of blood counts, bone marrow images, specialized protein tests, as well as a radiological examination of the skeleton.

Treatment

Treatment of multiple myeloma is long-term, requires regularity and medical supervision. Usually, it is pharmacological treatment that inhibits proliferation, i.e. the growth of abnormal cells, but in the case of fractures, it can sometimes be orthopedic.

In order to stimulate ossification in the foci of proliferation and bone destruction, and often to reduce pain sensation, X-ray irradiation is also undertaken.

The rationale for prophylaxis is discussed elsewhere.