White cell count abnormalities – a4medicine dolor lumbar agudo.co.uk

Monocytes- Constitute 3-8 % of the WCC Remain for a relatively short time in the circulation- after which they migrate to tissues and body cavities where they differentiate into macrophages They play a role in the inflammatory process ( members
of the mononuclear phagocyte system ) Good evidence exists to suggest that blood monocytes consist of several populations

Monocytosis – Associated with infection and inflammatory process escoliosis lumbar tratamiento Causes can be ○ Reactive monoytes
Infection- commonest cause
Inflammatory conditions as collagen vascular disease
chronic neutropenia
hemolytic anaemia
Haematopoetic and non Haemtopoetic neoplasms ○ Neoplastic Monocytes
several primary hematologic neoplasms harbor neoplastic monocytes including CMML , AMl with monocytic differentiation and myeloproloferative neoplasms as CML

causes- Infection Inflammation Necrosis Steroids Pregnancy Smoking Underlying cancer e.g CML. Red flags -A rapid rise Unwell patient Splenomegaly Cytopenias Abnormal blood film Left shift ( more immature as they are being released earlier ).Consider spurious neutrophilia ( eg due to platelet clumping or cryoglobulinaemia ) If cause unclear ask for CRP , U/E , LFT , Immunoglobulins , Serum free lite assay , Autoimmune screen , PSA ( based on clinical suspicion ) For well people a repeat in 4-6 wks is widely recommended

Refer- Suspected acute leukaemia Suspected Chronic myeloid leukaemia -usually moderate ↑↑ in neutrophil count 50 x 109 with a left shift and a prominence of myelocytes ( basophilia and eosinophilia may also be present ) Unexplained leucocytosis 50 x 109 Neutrophilia problemas lumbares 15 x 109 ( persistent and unexplained ) Associated splenomegaly or other FBC abnormalities

Referral- No clear cause – consider repeating in 4-6 wks with blood film + glandular fever/HIV screen ( if clinical suspicion ). Refer urgently to r/o Neoplastic lymphocytosis Unexplained persistent lymphocytosis 10 x 109 – refer routinely. Lymphocyte morphology can help distinguish between reactive and neoplastic causes. If atypical lymphocytes present consider infectious mononucleosis and viral serology

Assessment – Detailed medical hx Thorough physical examination Check for allergic disorders , skin rashes and cardiorespiratory , GI and constitutional symptoms Detailed travel history ( even in remote past ) Detailed drug history Risk factors for malignancy. Further testing -Blood film Inflammatory markers CRP / ESR Renal , LFT and bone profile LDH Vit B12 CXR Serum IgE Autoantibodies if evidence of autoimmune dis eg
ANA , ENA , anti-dsDNA , RhF , ANCA Stool culture for parasites. causes of eosinophilia -Myeloproliferative disorders May also be present with Hodgkin’s lymphoma and T-cell lympoma.Infections hernia discal lumbar cie 10 -particularly parasites Drugs e.g penicillins , carbamezapine Asthma / atopic dermatitis / acute urticarial Conn tissue disease e.g Rh arthritis, Polyarteritis nodosa, Wegeners granulomatosis ) Solid malignancy ( eg breast , renal and lung cancer ) Hypereosinophilic syndrome- diagnosis of exclusion ( associated with end organ damage , particularly cardiac )

Management – 1.5 x 109 and severe or potentially severe life threatening clinical manifestations or eosinophil rising rapidly-Discuss with O/C Haematologist ( tel ) to arrange an urgent assessment. Unclear cause-Repeat FBC Also ask for UsEs , CRP, auto-immune screen Stool for ova and parasites Consider CXR-Persistent unexplained 1.5 x 109 for 3 months – Refer Rising without an obvious cause – Refer If travel hx- d/w Infectious dis/ Micro

References Evaluation of Patients with Leukocytosis Lyrad K Riley MS et al AAFP 2015 Complete Blood Count in Primary Care BPAC NZ better medicine Leuokopenia Elizabeth Birk-Urowitz Family and Community Medicine – University of Toronto King’s Health Partners Haematology Institute and Network GP Referral guide Adult Haematology Incidental finding of lymphocytosis in an asymptomatic patient BMJ 2009 ; 338: b2119 Lymphocytopenia escoliosis dorsolumbar by Mary Territo MD MSD Manuals professional version Practical approach to the patient with hypereosinophilia Florence Roufosse , MD American Academy of Allergy , Asthma and cirugia lumbar Immunology 2010 Haematology in Primary Care Dr Josh Wright Sheffield Teaching Hospitals UH Bristol Haematology referral guideline for Primary Care May 2016 Monocytes an overview by ScienceDirect Ask the hematopathologist : Diagnostic Approach to Monocytosis The Hematologist July-August 2016 , Volume 13 , Issue 4

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