The Fellow on Call: The Heme/Onc Podcast Episode 051: Heme Consults Series- Approach to Inpatient Leukocytosis
Apr 5, 2023
Dive into the complexities of leukocytosis with insights on initial triage steps and essential history-taking. Learn about the physiology behind leukocyte behaviors and the importance of cell differentiation pathways. Discover the practical approaches to various types of white blood cell increases, from neutrophilia to lymphocytosis. Key laboratory tests and screening techniques are highlighted, along with expert tips on when to refer cases to hematology. It's an informative resource for clinicians navigating challenging inpatient scenarios!
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Weekend Consult Case That Sparked The Episode
- Roanuck presented a case: a 56‑year‑old woman with COPD admitted with WBC 25k that stayed ~23k despite improvement.
- The consult illustrates a common inpatient question prompting the episode's framework.
Why Leukocytosis Can Rise Overnight
- Most circulating WBCs are a tiny fraction; ~90% are stored in marrow or marginated.
- Demargination (stress, steroids) rapidly raises circulating neutrophils without new production.
Verify Chronicity And Medication Triggers
- Check prior labs to determine chronicity before worrying about malignancy.
- Ask about meds (G-CSF, steroids, lithium) and recent treatments that raise counts.