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Translational Pediatrics Dec 2022Neonatal leukemoid reaction (NLR) is often accompanied by infectious or non-infectious diseases, a low birth weight, sepsis, prematurity, ventricular hemorrhage, and...
BACKGROUND
Neonatal leukemoid reaction (NLR) is often accompanied by infectious or non-infectious diseases, a low birth weight, sepsis, prematurity, ventricular hemorrhage, and bronchial dysplasia. It has an incidence rate of 1.3-15% and a mortality rate of about 41.4%. Previous studies on NLR have largely focused on its pathogenesis and clinical cases, but little is known about its prognostic laboratory indicators. We found that some of the NLR exhibited obviously elevation in liver function tests like aspartate transaminase (AST) and lactate dehydrogenase (LDH) which were not took by all the LR infants. The necessity for liver function tests for the prognosis of NLR was still unclear.
METHODS
A total of 39 premature infants with NLR at the First Hospital of Jilin University between March 2016 and March 2017 were included in this retrospective cohort study. The infants were divided into death and cured group based on the clinical outcomes. Premature infants with LR and death were defined as the case group (n=14), while infants without death were defined as the control group (n=25). Confounding factors such as age and gender between the two groups were controlled. Blood routine tests, including the white blood cell (WBC) count and subtypes, and liver function, and clinical features were recorded and analyzed. T tests were used to examine the differences in the laboratory indicators between the NLR and control groups. Receiver operating characteristic curves (ROCs) and areas under the curve (AUCs) were used to examine laboratory indicators for prognosis.
RESULTS
For predicting clinical outcomes, the ROC curves showed that the cut-off values for AST and LDH were 279 and 1,412 U/L, respectively. The sensitivity and specificity for AST were 92% and 71.43%, respectively, with an AUC of 0.894, while the sensitivity and specificity for LDH were 88% and 78.57%, respectively, with an AUC of 0.911.
CONCLUSIONS
This innovative study investigated the NLR prognosis depending on laboratory tests. We found that serum AST and LDH levels had reliable predictive value in determining adverse outcomes of NLR.
PubMed: 36643666
DOI: 10.21037/tp-22-543 -
Cureus Sep 2021Leukemoid reaction is defined by a leukocyte level above 50 x 10/µL with a predominance of mature neutrophils and the presence of immature granulocytic forms in the...
Leukemoid reaction is defined by a leukocyte level above 50 x 10/µL with a predominance of mature neutrophils and the presence of immature granulocytic forms in the peripheral blood (left shift). We report a case of a 36-year-old woman with severe coronavirus disease 2019 (COVID-19) infection admitted to the ICU with a leukocytosis of 70.9 x 10/µL white blood cells (WBC) throughout her hospitalization. A left shift with bandemia along with toxic granulations was also noticed and further investigation excluded more commonly known causes. A presumptive diagnosis of leukemoid reaction was made secondary to COVID-19 infection; however, it could not be confirmed since workup for lymphoproliferative disorders could not be performed as the patient passed away. The leukemoid reaction could be associated with severe COVID-19 infection; however, more data are needed to evaluate this association.
PubMed: 34527502
DOI: 10.7759/cureus.17865 -
Mayo Clinic Proceedings Jul 2010The association between malignancy and development of a paraneoplastic leukocytosis, the so-called leukemoid reaction, has long been appreciated. Although a leukemoid... (Review)
Review
The association between malignancy and development of a paraneoplastic leukocytosis, the so-called leukemoid reaction, has long been appreciated. Although a leukemoid reaction has conventionally been defined as a peripheral blood leukocytosis composed of both mature and immature granulocytes that exceeds 50,000/microL, a less profound leukocytosis may be appreciated in many patients harboring a malignant disease. More recent insights have shed new light on this long-recognized association, because research performed in both murine models and cancer patients has uncovered multiple mechanisms by which tumors both drive myelopoiesis, sometimes leading to a clinically apparent leukocytosis, and inhibit the differentiation of myeloid cells, resulting in a qualitative change in myelopoiesis. This qualitative change leads to the accumulation of immature myeloid cells, which due to their immune suppressive effects have been collectively called myeloid-derived suppressor cells. More recently, myeloid cells have been shown to promote tumor angiogenesis. Cancer-associated myeloproliferation is not merely a paraneoplastic phenomenon of questionable importance but leads to the suppression of host immunity and promotion of tumor angiogenesis, both of which play an integral part in tumorigenesis and metastasis. Therefore, cancer-associated myeloproliferation represents a novel therapeutic target in cancer that, decades after its recognition, is only now being translated into clinical practice.
Topics: Animals; CD11b Antigen; Cell Differentiation; Cocarcinogenesis; Disease Models, Animal; HLA-DR Antigens; Humans; Immune Tolerance; Inflammation; Leukemoid Reaction; Leukocytosis; Mice; Myeloid Cells; Myelopoiesis; Neoplasm Metastasis; Neoplasms; Neovascularization, Pathologic; Prognosis; Vascular Endothelial Growth Factor A
PubMed: 20592171
DOI: 10.4065/mcp.2010.0077 -
Journal of Medical Case Reports May 2014Granulocyte colony-stimulating factor produced by nonhematopoietic malignant cells is able to induce a leukemoid reaction by excessive stimulation of leukocyte... (Review)
Review
Leukemoid reaction and autocrine growth of bladder cancer induced by paraneoplastic production of granulocyte colony-stimulating factor--a potential neoplastic marker: a case report and review of the literature.
INTRODUCTION
Granulocyte colony-stimulating factor produced by nonhematopoietic malignant cells is able to induce a leukemoid reaction by excessive stimulation of leukocyte production. Expression of granulocyte colony-stimulating factor and its functional receptors have been confirmed in bladder cancer cells. In vitro studies have demonstrated that granulocyte colony-stimulating factor/receptor exhibits a high affinity binding and this biological axis increases proliferation of the carcinoma. Urothelial carcinoma of the bladder is rarely associated with a leukemoid reaction and autocrine growth induced by paraneoplastic production of granulocyte colony-stimulating factor. In the world literature, there have been less than 35 cases reported in the last 35 years. The clinicopathological aspects, biology, prognosis and management of granulocyte colony-stimulating factor-secreting bladder cancers are poorly understood.
CASE PRESENTATION
A 39-year-old Caucasian woman with an invasive high-grade urothelial carcinoma presented with hematuria and low-grade fevers. Laboratory tests revealed an elevated white blood cell count and absolute neutrophil count and an elevated 24-hour urine protein. Upon further evaluation she was found to have locally advanced high-grade urothelial carcinoma without nodal or distant metastasis. Her serum granulocyte colony-stimulating factor level was 10 times the normal limit. This led to the diagnosis of a paraneoplastic leukemoid reaction. Her white blood cell count immediately normalized after cystectomy but increased in concordance with recurrence of her disease. Unfortunately, she rapidly progressed and expired within 10 months from the time of first diagnosis.
CONCLUSIONS
This is one of the few cases reported that illustrates the existence of a distinct and highly aggressive subtype of bladder cancer which secretes granulocyte colony-stimulating factor. Patients presenting with a leukemoid reaction should be tested for granulocyte colony-stimulating factor/receptor biological axis. Moreover, granulocyte colony-stimulating factor could be a potential neoplastic marker as it can follow the clinical course of the underlying tumor and thus be useful for monitoring its evolution. Neoadjuvant chemotherapy should be considered in these patients due to the aggressive nature of these tumors. With a better understanding of the biology, this autocrine growth signal could be a potential target for therapy in future.
Topics: Adult; Autocrine Communication; Carcinoma, Transitional Cell; Female; Granulocyte Colony-Stimulating Factor; Humans; Leukemoid Reaction; Paraneoplastic Endocrine Syndromes; Urinary Bladder Neoplasms
PubMed: 24885603
DOI: 10.1186/1752-1947-8-147 -
British Journal of Haematology Nov 2015Many cases reported as 'chronic neutrophilic leukaemia' have had an associated plasma cell neoplasm. Recent evidence suggests that the great majority of such cases... (Review)
Review
Many cases reported as 'chronic neutrophilic leukaemia' have had an associated plasma cell neoplasm. Recent evidence suggests that the great majority of such cases represent a neutrophilic leukaemoid reaction to the underlying multiple myeloma or monoclonal gammopathy of undetermined significance. We have analysed all accessible reported cases to clarify the likely diagnosis and to ascertain whether toxic granulation, Döhle bodies and an increased neutrophil alkaline phosphatase score were useful in making a distinction between chronic neutrophilic leukaemia and a neutrophilic leukaemoid reaction. We established that all these changes occur in both conditions. Toxic granulation and Döhle bodies are more consistently present in leukaemoid reactions but also occur quite frequently in chronic neutrophilic leukaemia. The neutrophil alkaline phosphatase score is increased in both conditions and is of no value in making a distinction.
Topics: Cell Degranulation; Female; Humans; Inclusion Bodies; Leukemia, Myeloid, Acute; Leukemia, Neutrophilic, Chronic; Male; Monoclonal Gammopathy of Undetermined Significance; Multiple Myeloma; Neoplasms, Second Primary
PubMed: 26218186
DOI: 10.1111/bjh.13600 -
The Journal of International Medical... Jan 2021Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the... (Review)
Review
Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the case of a 28-year-old healthy female without exceptional past medical history, who suffered from severe vaginal infection, is reported. Although symptoms improved, the white blood cell (WBC) count continued to increase up to 78 460 cells/µl, however, the patient continued to improve and the outcome was good. The case revealed that an increasing WBC count may not change in synchrony with clinical symptoms. When faced with this scenario, procalcitonin measurements may play an important role in differentiating diagnosis and guiding treatment.
Topics: Adult; Communicable Diseases; Female; Humans; Leukemoid Reaction; Leukocyte Count; Leukopenia; Thrombocytopenia
PubMed: 33423588
DOI: 10.1177/0300060520974257 -
IDCases 2023is a common cause of community acquired pneumonia and although most cases are mild, complications sometimes occur. Cold agglutinin hemolysis is a known complication of...
is a common cause of community acquired pneumonia and although most cases are mild, complications sometimes occur. Cold agglutinin hemolysis is a known complication of infection, and usually presents as a mild and transient hemolysis. Here we present a case of infection with in a 64-year-old male that caused life threatening hemolysis that required multiple blood transfusions. The patient also presented with acute kidney failure and a marked leukemoid reaction and thrombocytosis. This is a very rare combination of symptoms that could have led the clinicians to suspect a more virulent etiology than , thereby delaying adequate antibiotic treatment.
PubMed: 36687368
DOI: 10.1016/j.idcr.2023.e01689 -
Nature Reviews. Cancer Oct 2013Tumour-induced granulocytic hyperplasia is associated with tumour vasculogenesis and escape from immunity via T cell suppression. Initially, these myeloid cells were... (Review)
Review
Tumour-induced granulocytic hyperplasia is associated with tumour vasculogenesis and escape from immunity via T cell suppression. Initially, these myeloid cells were identified as granulocytes or monocytes; however, recent studies have revealed that this hyperplasia is associated with populations of multipotent progenitor cells that have been identified as myeloid-derived suppressor cells (MDSCs). The study of MDSCs has provided a wealth of information regarding tumour pathobiology, has extended our understanding of neoplastic progression and has modified our approaches to immune adjuvant therapy. In this Timeline article, we discuss the history of MDSCs, their influence on tumour progression and metastasis, and the crosstalk between tumour cells, MDSCs and the host macroenvironment.
Topics: Animals; Antigens, Differentiation; Antigens, Neoplasm; Cell Biology; Cell Differentiation; Cell Lineage; Chemokines; Hematopoiesis, Extramedullary; Hematopoietic Stem Cell Mobilization; History, 20th Century; History, 21st Century; Humans; Leukemoid Reaction; Medical Oncology; Mice; Molecular Targeted Therapy; Multipotent Stem Cells; Myeloid Cells; Myeloid Progenitor Cells; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasms; Neovascularization, Pathologic; Tumor Burden; Tumor Escape; Tumor Microenvironment
PubMed: 24060865
DOI: 10.1038/nrc3581 -
Romanian Journal of Internal Medicine =... Sep 2019Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such... (Review)
Review
INTRODUCTION
Several diagnoses have been associated with leukemoid reaction (LR). In patients with LR the diagnostic and prognostic value of detailed manual blood smear counts (such as the percentage of band cells or grading of neutrophil toxic changes) has not been studied previously.
METHODS
We prospectively recorded all hospitalized adult (> 18 years old) patients with LR (≥ 30000/ul) of neutrophilic predominance, excluding patients with pre-existing leukocytosis due to hematological malignancies. We examined the diagnoses and prognosis (in-hospital mortality and post-discharge mortality up to a year after the end of the study) of these patients as well as the value of manual peripheral smear review.
RESULTS
We recorded a total of 93 patients with LR from January 2017 to December 2017. Infection was the most common diagnosis (70%), followed by malignancy (7.5%) and bleeding (6.5%). In-hospital mortality (45%) and post-discharge mortality (35% of those discharged) were very high. Among blood smear findings, only neutrophil vacuolation was significantly more common in patients with infections (34%), although it was also observed in many patients without any infection (13%). Blood smear findings were not associated with prognosis.
CONCLUSION
Detailed manual smear review is a labor-intensive procedure and it has limited diagnostic and prognostic value in unselected hospitalized patients with neutrophilic LR.
Topics: Adult; Aged; Aged, 80 and over; Blood Cell Count; C-Reactive Protein; Female; Hemorrhage; Hospital Mortality; Hospitalization; Humans; Infections; Leukemoid Reaction; Male; Middle Aged; Neoplasms; Neutrophils; Prognosis; Prospective Studies
PubMed: 30862764
DOI: 10.2478/rjim-2019-0006 -
The Tohoku Journal of Experimental... Feb 2018Leukemoid reaction (LR) is a reactive disease that exhibits abnormal blood values similar to leukemia, but not due to leukemia. One report showed that neonatal LR (NLR)...
Leukemoid reaction (LR) is a reactive disease that exhibits abnormal blood values similar to leukemia, but not due to leukemia. One report showed that neonatal LR (NLR) was associated with elevated serum granulocyte colony stimulating factor (G-CSF) in only 30% of the study neonates. NLR is not always associated with the elevation of serum G-CSF. NLR was defined as a white blood cell count of ≥ 40 × 10/μL and/or blast cell concentration of > 2%. We have focused on NLR with fetal inflammatory response syndrome (FIRS), defined as a fetal systemic inflammatory reaction triggered by intrauterine infection. FIRS was diagnosed based on a cord serum interleukin-6 (IL-6) concentration ≥ 17.5 pg/mL and histopathological chorioamnionitis. Because NLR is highly associated with FIRS, we have hypothesized that NLR is associated with the elevation of both G-CSF and IL-6. This is the first report to measure multiple cytokines in NLR at the same time. The study comprised 19 preterm infants with FIRS: 8 with NLR (study group) and 11 without NLR (control group). Serum G-CSF and IL-6 concentrations were significantly higher in the study group than the control group. There was a positive correlation between G-CSF and IL-6 levels in the study group but not in the control group. These results suggest that elevated serum G-CSF and IL-6 may underlie NLR. Thus, G-CSF and IL-6 concentrations may be predictive of the onset of NLR. Measuring these cytokines is useful for judging the prognosis of preterm infants and for their post-natal clinical management.
Topics: Case-Control Studies; Female; Fetus; Granulocyte Colony-Stimulating Factor; Humans; Infant, Newborn; Inflammation; Interleukin-6; Leukemoid Reaction; Male; Syndrome
PubMed: 29459579
DOI: 10.1620/tjem.244.145