Evaluation of neutrophilia

Summary

Neutrophilia may occur with or without an elevated white blood cell (WBC) count (leukocytosis). Neutrophilia without leukocytosis is defined as an elevated circulating neutrophil count (>7700/microliter) in adults with a normal total WBC count of <11,000/microliter.[1] An elevated total WBC count (>11,000/microliter) and an absolute neutrophil count >7700/microliter is defined as a neutrophilic leukocytosis.[1]

The absolute neutrophil count can be estimated by multiplying the total WBC count by the percentage of polymorphonuclear cells and band forms (immature neutrophils have a band-shaped nucleus).[2]

The terms granulocytosis and neutrophilia are often used interchangeably, although granulocytosis also includes elevations in eosinophils and basophils.

The terms hyperleukocytosis and leukemoid reaction are reserved for total leukocyte counts of >50,000/microliter. Leukemoid reaction may mimic leukemia, but has a nonmalignant etiology.

Neutrophilia results from:

Increased production of neutrophils

Demargination (process of neutrophils entering the peripheral circulation from areas of intravascular marginated polymorphonuclear cell pools), or

Decreased egress (outward migration) of neutrophils from peripheral circulation to the tissues.Image

Epidemiology

Many diverse factors contribute to the development of neutrophilia, so defining the population at risk is difficult. Individuals carrying a Duffy null (Fy(a-b-)) phenotype, which is protective against Plasmodium vivax infection of red blood cells, have a lower absolute neutrophil count (mean difference 700 cells/microliter) than other individuals and may therefore be considered to have neutrophilia at a lower count.[3]

The neutrophil count changes with age, with the highest counts seen in the first few days after birth, then decreasing rapidly. Neutrophil counts approach adult levels around age 10. Lifestyle factors, including exercise levels, stress, and smoking status, influence the risk of neutrophilia.

Library

Neutrophilia
BCR::ABL1 translocation
Toxic granules in a patient receiving granulocyte colony-stimulating factor treatment
Leukoerythroblastic peripheral blood smear with dacrocytes
Neutrophilia with left shift
Leukoerythroblastic peripheral blood smear

Citations

Key Articles

Hoffman R, Benz E, Silberstein L, et al. Hematology basic principles and practice. 7th ed. Philadelphia, PA: Elsevier Churchill Livingston; 2017.

Referenced Articles

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