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Leukemoid reaction: A 21st‐century cohort study
Introduction Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, i...
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| Published in: | International journal of laboratory hematology 2020-04, Vol.42 (2), p.134-139 |
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| container_end_page | 139 |
| container_issue | 2 |
| container_start_page | 134 |
| container_title | International journal of laboratory hematology |
| container_volume | 42 |
| creator | Portich, Júlia P. Faulhaber, Gustavo A. M. |
| description | Introduction
Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes.
Methods
This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan‐Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death.
Results
Of the 267 cases with white blood cell count of >50 × 109, 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P |
| doi_str_mv | 10.1111/ijlh.13127 |
| format | article |
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Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes.
Methods
This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan‐Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death.
Results
Of the 267 cases with white blood cell count of >50 × 109, 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log‐rank [Mantel‐Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death.
Conclusions
This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.</description><identifier>ISSN: 1751-5521</identifier><identifier>EISSN: 1751-553X</identifier><identifier>DOI: 10.1111/ijlh.13127</identifier><identifier>PMID: 31765058</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Age Factors ; Aged ; Blood ; Cohort analysis ; Demography ; Disease-Free Survival ; Etiology ; extreme neutrophilic leukocytosis ; Female ; Health risk assessment ; Hemoglobin ; Hemoglobins - metabolism ; Humans ; infection leukocytosis ; Leukemoid reaction ; Leukemoid Reaction - blood ; Leukemoid Reaction - mortality ; Leukocyte Count ; leukocytosis ; Male ; Medical prognosis ; Middle Aged ; paraneoplastic leukemoid reaction ; Patients ; Prognosis ; Retrospective Studies ; Survival analysis ; Survival Rate ; Tumors</subject><ispartof>International journal of laboratory hematology, 2020-04, Vol.42 (2), p.134-139</ispartof><rights>2019 John Wiley & Sons Ltd</rights><rights>2019 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3577-6df165587f05cfa73b8a47159008a2389262d1cf1a3ba3ea3b61ed3bc213df23</citedby><cites>FETCH-LOGICAL-c3577-6df165587f05cfa73b8a47159008a2389262d1cf1a3ba3ea3b61ed3bc213df23</cites><orcidid>0000-0002-4633-2903 ; 0000-0001-7064-0992</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31765058$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Portich, Júlia P.</creatorcontrib><creatorcontrib>Faulhaber, Gustavo A. M.</creatorcontrib><title>Leukemoid reaction: A 21st‐century cohort study</title><title>International journal of laboratory hematology</title><addtitle>Int J Lab Hematol</addtitle><description>Introduction
Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes.
Methods
This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan‐Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death.
Results
Of the 267 cases with white blood cell count of >50 × 109, 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log‐rank [Mantel‐Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death.
Conclusions
This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Blood</subject><subject>Cohort analysis</subject><subject>Demography</subject><subject>Disease-Free Survival</subject><subject>Etiology</subject><subject>extreme neutrophilic leukocytosis</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Hemoglobin</subject><subject>Hemoglobins - metabolism</subject><subject>Humans</subject><subject>infection leukocytosis</subject><subject>Leukemoid reaction</subject><subject>Leukemoid Reaction - blood</subject><subject>Leukemoid Reaction - mortality</subject><subject>Leukocyte Count</subject><subject>leukocytosis</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>paraneoplastic leukemoid reaction</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival analysis</subject><subject>Survival Rate</subject><subject>Tumors</subject><issn>1751-5521</issn><issn>1751-553X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp90DFOwzAUBmALgWgpLBwARWJBSAE_O44TtqoCWhSJpQNb5DiOmpLExU6EsnEEzshJcEnpwIAH28OnX-_9CJ0DvgF3bst1tboBCoQfoDFwBj5j9OVw_ycwQifWrjFmPMDxMRpR4CHDLBojSFT3qmpd5p5RQralbu68qUfAtl8fn1I1bWd6T-qVNq1n2y7vT9FRISqrznbvBC0f7pezuZ88Py5m08SXlHHuh3kBIWMRLzCTheA0i0TAgcUYR4LQKCYhyUEWIGgmqHJ3CCqnmSRA84LQCboaYjdGv3XKtmldWqmqSjRKdzYlboeYxRwCRy__0LXuTOOGc4qzgPIoCJ26HpQ02lqjinRjylqYPgWcbntMtz2mPz06fLGL7LJa5Xv6W5wDMID3slL9P1Hp4imZD6HfjKp78g</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Portich, Júlia P.</creator><creator>Faulhaber, Gustavo A. M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4633-2903</orcidid><orcidid>https://orcid.org/0000-0001-7064-0992</orcidid></search><sort><creationdate>202004</creationdate><title>Leukemoid reaction: A 21st‐century cohort study</title><author>Portich, Júlia P. ; Faulhaber, Gustavo A. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3577-6df165587f05cfa73b8a47159008a2389262d1cf1a3ba3ea3b61ed3bc213df23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Blood</topic><topic>Cohort analysis</topic><topic>Demography</topic><topic>Disease-Free Survival</topic><topic>Etiology</topic><topic>extreme neutrophilic leukocytosis</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Hemoglobin</topic><topic>Hemoglobins - metabolism</topic><topic>Humans</topic><topic>infection leukocytosis</topic><topic>Leukemoid reaction</topic><topic>Leukemoid Reaction - blood</topic><topic>Leukemoid Reaction - mortality</topic><topic>Leukocyte Count</topic><topic>leukocytosis</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>paraneoplastic leukemoid reaction</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Survival analysis</topic><topic>Survival Rate</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Portich, Júlia P.</creatorcontrib><creatorcontrib>Faulhaber, Gustavo A. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of laboratory hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Portich, Júlia P.</au><au>Faulhaber, Gustavo A. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Leukemoid reaction: A 21st‐century cohort study</atitle><jtitle>International journal of laboratory hematology</jtitle><addtitle>Int J Lab Hematol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>42</volume><issue>2</issue><spage>134</spage><epage>139</epage><pages>134-139</pages><issn>1751-5521</issn><eissn>1751-553X</eissn><abstract>Introduction
Leukemoid reaction (leukocyte count >50 cells ×109 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 109 L, including etiology and outcomes.
Methods
This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×109 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan‐Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death.
Results
Of the 267 cases with white blood cell count of >50 × 109, 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log‐rank [Mantel‐Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death.
Conclusions
This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31765058</pmid><doi>10.1111/ijlh.13127</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4633-2903</orcidid><orcidid>https://orcid.org/0000-0001-7064-0992</orcidid></addata></record> |
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| subjects | Adult Age Factors Aged Blood Cohort analysis Demography Disease-Free Survival Etiology extreme neutrophilic leukocytosis Female Health risk assessment Hemoglobin Hemoglobins - metabolism Humans infection leukocytosis Leukemoid reaction Leukemoid Reaction - blood Leukemoid Reaction - mortality Leukocyte Count leukocytosis Male Medical prognosis Middle Aged paraneoplastic leukemoid reaction Patients Prognosis Retrospective Studies Survival analysis Survival Rate Tumors |
| title | Leukemoid reaction: A 21st‐century cohort study |
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