HNY Policy and Pathway Repository - North Yorkshire

Note the particular cell line increased, i.e. neutrophilia, monocytosis, eosinophilia or lymphocytosis.

None provided

Differential Diagnosis:

Neutrophilia

• Reactive - most commonly seen as a reactive feature secondary to infection, inflammation, trauma or malignancy. May have increased monocytes and platelets. May develop anaemia of chronic disease.
• Medication - e.g. corticosteroids or G-CSF. Cigarette smoking
• Post-splenectomy
• Chronic myeloid leukaemia (CML) rare condition, often very high white cell count with coexisting splenomegaly, eosinophilia, basophilia and primitive cells in the peripheral blood. These characteristic features will usually be picked-up by the haematology laboratory.

Monocytosis

• Reactive - most commonly seen as a reactive feature, often with a neutrophilia.
• Chronic myelomonocytic leukaemia (CMML) often with cytopenias and dysplastic features on a blood film.

Eosinophilia

• Most common causes are allergy / atopy or drug reaction.
• Less common causes are wide-ranging, including parasitic infection, tuberculosis, HIV, malignancy, connective tissue disease / vasculitis, sarcoidosis, skin disease or pulmonary disease (e.g. allergic bronchopulmonary aspergillosis, Lofttler's syndrome). Can be seen in haematological malignancies.

Examination:

• Difficult to give specific recommendations given the wide-range of possible causes.
• Examine for hepatomegaly and splenomegaly if suspect CML or CMML.
• If unexplained eosinophilia then consider eosinophil related organ damage which can cause cardiac, pulmonary, gastrointestinal, renal, musculoskeletal, neurological and skin damage.

Baseline investigations:

• FBC, blood film, U&E, LFT, inflammatory markers.
• Other investigations as directed by symptoms and suspected underlying cause.

Referral:

• Consider Haematology referral if:
  • Suspicion of haematological malignancy - chronic myeloid leukaemia or chronic myelomonocytic leukaemia.
  • Sustained eosinophilia (>1.5 x10 9 /L) in absence of a secondary cause or with suspicion of associated end organ damage.
• If unexplained inflammatory process then consider referral to General Medicine, or other speciality based on any localising features.

Haematology Handbook - South Tees Hospitals NHS Foundation Trust

• South Tees Hospitals