DIAGNOSIS AND OUTCOME OF 100 CONSECUTIVE PATIENTS WITH EXTREME GRANULOCYTIC LEUKOCYTOSIS

PURPOSE: To determine the clinical features, causes, and prognostic si gnificance of extreme leukocytosis in adults. PATIENTS AND METHODS: Me dical records of 100 consecutive patients who presented al the Minneap olis Veterans Affairs Medical Center between March 1993 and January 19 94 with more than 25,000 leukocytes/mu L blood and with more than 50% granulocytes were reviewed. Demographic, clinical, and outcome informa tion was recorded, and a cause of extreme leukocytosis was sought in e ach case. RESULTS: Extreme leukocytosis was attributed to infection in 48 cases, advanced malignancy in 13 cases, hemorrhage in 9 cases, glu cocorticoids in 8 cases, and other causes in 22 cases. Four patients h ad previously diagnosed conditions resulting in chronic leukocytosis. Higher leukocyte counts were associated with malignancy (chi(2) for tr end=12.5, P <0.002). Fever was more common in patients with infection (weighted rate ratio=3.7, 95% Confidence interval [CI]=2.2 to 6.2). Mo rtality was high overall (31%), and was greater in patients with nonin fectious diagnoses compared with infected patients, an association whi ch persisted after stratification by leukocyte count (weighted rate ra tio=2.5, 95% CI=1.2 to 4.9). CONCLUSION: Clinicians should be aware th at extreme leukocytosis with a predominance of granulocytes is associa ted with infection in only 48% of cases. The presence of fever increas es the likelihood that infection is the cause. Mortality is high, part icularly in patients without infection. (C) 1998 by Excerpta Medica, I nc.