Bloody Minded Episode 55 - Too much of a good thing | Approaching Neutrophilia
Jul 29, 2025
Dive into the complexities of neutrophilia, where an elevated neutrophil count isn't always a bad thing! Discover reactive causes versus spurious elevations and the surprising effects of steroids. The discussion touches on how smoking influences neutrophil counts and connects chronic neutrophilia to conditions like chronic myeloid leukemia. With anecdotes and a dash of humor, the hosts explore rare disorders linked to neutrophilia and emphasize the importance of thorough investigation to understand these dynamics in clinical practice.
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Defining Neutrophilia and Left Shift
- Neutrophilia is defined as an absolute neutrophil count above approximately 7.5 x 10^9/L, typically corresponding to a total white count around 12. - Immature granulocytes in peripheral blood indicate a "left shift," which signals increased marrow release but is not diagnostic by itself.
Categorizing Neutrophilia Causes
- Causes of neutrophilia fall into three categories: reactive, spurious, and clonal. - These categories relate to making too many cells, altered cell destruction, or redistribution.
Steroids Cause Demargination
- Steroids cause neutrophilia mainly by demargination, releasing neutrophils stuck on vessel walls into circulation. - This increases circulating neutrophils without increasing total body neutrophil numbers.