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Why is my neutrophil count high?

Wednesday, 13 June 2007
Answered by: Dr. Shirish Kumar
Consultant Haematologist,
Sir Ganga Ram Hospital,
New Delhi
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Q. Two years ago I had an emergency appendectomy (the appendix did not rupture). On the day, I was supposed to go home from the hospital, I developed fever and my WBC went up, leading my doctor to think that I developed pocket infection. They started antibiotics and sent me home a few days later. I continued the antibiotics for 1 week. But still my WBC was high. So they made me continue oral antibiotics and said that should clear it up. It has been 2 years and recently I underwent blood work to check if I was anaemic due to my heavy periods, but I wasn't. Still the CBC showed a WBC of 14.3. One week later the CBC was repeated and the WBC was 13.8. I was referred to a haematologist who did another blood work 3 weeks after the last CBC. My WBC is now 16.2. I do not feel sick or have any pain. The haematologist also said that my neutrophils were high, it shows on the report as GRAN 10.3. He believes it is due to my smoking habit, as I smoke 1 pack a day. I asked about leukaemia and he said that he did not see any leukaemia cells on the smear. Is he right? Can it be anything else?

A.  Neutrophils are a type of white blood cells, which protect the body against infectious agents by migrating toward the source of irritation. Neutrophilia refers to a higher than normal number of neutrophils for age or sex of the individual. The increase in their number may be a result of a shift of cells from the capillaries and organs to the blood (shift neutrophilia) or from a true increase in their number caused by increased production (true neutrophilia). Shift neutrophilia is usually transient, may occur in association with vigorous exercise or stress (following meals, pregnancy, smoking, seizures or tachycardia) and usually lasts 20-30 minutes. True neutrophilia is usually related to infections and leads to increased production of cells in the marrow. If the demand of cells is high, immature neutrophils escape from the marrow into the blood (called a shift to the left in the differential count). Neutrophilia can occur from
  1. Acute infections caused by bacteria (staphylococci, pneumococci, streptococci, meningococci, gonococci, Escherichia coli, Pseudomonas aeruginosa, Actinomyces species); certain fungi (Coccidioides immitis); spirochetes; viruses (rabies, poliomyelitis, herpes zoster, small pox, varicella); rickettsia; and parasites (liver fluke)
  2. Non-infectious inflammatory states (like burns, post-operative state, acute myocardial infarction, acute attacks of gout, acute glomerulonephritis, intestinal obstruction, strangulated hernia, rheumatic fever, collagen vascular diseases, hypersensitivity reactions)
  3. Metabolic states (diabetic ketoacidosis, pre-eclampsia, uraemia)
  4. Poisoning
  5. Acute haemorrhage (into body spaces such as the peritoneal cavity, pleural cavity, joint cavity, intracranial space
  6. Myeloproliferative disorders (chronic myeloid leukaemia, polycythaemia vera, myelofibrosis, myeloid metaplasia)
  7. Malignant tumours
  8. Medications like acute or chronic administration of corticosteroids
  9. Chronic idiopathic neutrophilia and Hereditary neutrophilia - neutrophilia present without an identifiable cause.
As you can see the list of causes is large. You need a meticulous clinical examination followed by relevant investigations so that appropriate treatment can be instituted. It is important to remember that one treats an individual and not an abnormal test result.

A.  Neutrophils are a type of white blood cells, which protect the body against infectious agents by migrating toward the source of irritation. Neutrophilia refers to a higher than normal number of neutrophils for age or sex of the individual. The increase in their number may be a result of a shift of cells from the capillaries and organs to the blood (shift neutrophilia) or from a true increase in their number caused by increased production (true neutrophilia). Shift neutrophilia is usually transient, may occur in association with vigorous exercise or stress (following meals, pregnancy, smoking, seizures or tachycardia) and usually lasts 20-30 minutes. True neutrophilia is usually related to infections and leads to increased production of cells in the marrow. If the demand of cells is high, immature neutrophils escape from the marrow into the blood (called a shift to the left in the differential count). Neutrophilia can occur from
  1. Acute infections caused by bacteria (staphylococci, pneumococci, streptococci, meningococci, gonococci, Escherichia coli, Pseudomonas aeruginosa, Actinomyces species); certain fungi (Coccidioides immitis); spirochetes; viruses (rabies, poliomyelitis, herpes zoster, small pox, varicella); rickettsia; and parasites (liver fluke)
  2. Non-infectious inflammatory states (like burns, post-operative state, acute myocardial infarction, acute attacks of gout, acute glomerulonephritis, intestinal obstruction, strangulated hernia, rheumatic fever, collagen vascular diseases, hypersensitivity reactions)
  3. Metabolic states (diabetic ketoacidosis, pre-eclampsia, uraemia)
  4. Poisoning
  5. Acute haemorrhage (into body spaces such as the peritoneal cavity, pleural cavity, joint cavity, intracranial space
  6. Myeloproliferative disorders (chronic myeloid leukaemia, polycythaemia vera, myelofibrosis, myeloid metaplasia)
  7. Malignant tumours
  8. Medications like acute or chronic administration of corticosteroids
  9. Chronic idiopathic neutrophilia and Hereditary neutrophilia - neutrophilia present without an identifiable cause.
As you can see the list of causes is large. You need a meticulous clinical examination followed by relevant investigations so that appropriate treatment can be instituted. It is important to remember that one treats an individual and not an abnormal test result.

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