HNY Policy and Pathway Repository - York

A high number of neutrophils in the blood.

This is usually a reactive phenomenon and only rarely will represent a primary haematological malignancy. The finding of basophilia points towards a myeloproliferative neoplasm; especially chronic myeloid leukaemia. If there is an associated monocytosis which is persistent, see section on monocytosis.

Causes

• Infection – especially bacterial, leg ulcers, bronchiectasis
• Chronic inflammation, eg smoking, autoimmune disease
• Medications e.g. corticosteroids, GCSF, lithium
• Solid malignancy
• Haematological malignancy usually carries additional features eg thrombocytosis for MPN, basophilia for CML (neutrophilia is not specific for lymphoid tumours/myeloma)
• Stress events e.g. trauma, seizures, myocardial infarction, eclampsia etc.
• Hyposplenism

None provided

History and examination

Clinical evaluation asking about infective symptoms, travel history, smoking Examine for features of autoimmune disease, lymphadenopathy and splenomegaly.

 

Suggested investigations

• CRP
• Blood film
• Dependant on history and examination

 

Management

The management will vary from patient to patient depending on differential diagnosis, prior blood counts, result on repeat and clinical concern.

Referral or A&G (depending on clinical situation) to haematology is indicated

• additional thrombocytosis with normal CRP and no obvious underlying cause
• persistent (more than once) basophilia
• persistent eosinophilia without obvious reactive cause eg severe asthma/eczema
• splenomegaly