Complete Blood Count / CBC Interpretation (Leukocytosis)

MedCram - Medical Lectures Explained CLEARLY
21 Jul 201913:05
EducationalLearning
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TLDRThis MedCram lecture delves into leukocytosis, an elevated white blood cell (WBC) count, typically observed in hospital settings but also in outpatients. It explains the normal WBC range, the importance of monitoring trends, and the differential of WBC components. The lecture highlights the common causes of leukocytosis, including infections, steroids, cancer/leukemia, and catastrophic events. It also emphasizes the significance of a 'left shift' in WBC, indicative of bacterial infections, and the role of eosinophils in allergies and parasitic infections. The speaker advises on clinical signs to look for and diagnostic tests to confirm infections, as well as the impact of steroids on WBC levels and the potential for Clostridium difficile colitis in very high WBC counts.

Takeaways
  • 📈 Leukocytosis is defined as a white blood cell (WBC) count greater than 11 x 10^9 cells per liter.
  • 🕵️‍♂️ Trends in WBC counts are important; a decreasing WBC count may indicate resolution of an issue.
  • 🩺 Different types of white blood cells (neutrophils, lymphocytes, monocytes, eosinophils) have specific roles and their levels can indicate different conditions.
  • 🦠 Elevated neutrophils (bands and segmented neutrophils) typically indicate bacterial infections.
  • 🦠 Elevated lymphocytes are more typical for viral infections and tuberculosis.
  • 🌾 High eosinophil counts may indicate allergies, parasitic infections, or coccidioidomycosis.
  • 💊 Steroids can cause an increase in WBC counts through demargination and delayed migration.
  • 🧬 Leukemia or lymphomas can cause significantly elevated WBC counts, characterized by abnormal white blood cell production or longevity.
  • ⚠️ Very high WBC counts (30-50 x 10^9 cells per liter) may indicate Clostridium difficile colitis in hospitalized patients.
  • 🩻 Diagnostic tests (e.g., chest x-rays, urinalysis, CT scans) are crucial to identify underlying causes of leukocytosis, especially if an infection is suspected.
Q & A

  • What is leukocytosis?

    -Leukocytosis is a condition characterized by an elevated white blood cell (WBC) count, typically anything greater than 11 x 10^9/L. It can be seen in both inpatient and outpatient settings.

  • What is the normal range for WBC count?

    -The normal range for WBC count is approximately 4.5 to 11 x 10^9/L.

  • Why is it important to watch the trends in WBC count?

    -Watching the trends in WBC count helps in understanding whether the condition is resolving or worsening. For example, a WBC count of 13 might not be a concern if it was previously higher (e.g., 20) and is now decreasing.

  • What are the different types of white blood cells mentioned in the script?

    -The script mentions bands, segmented neutrophils (CEGs), lymphocytes, monocytes, and eosinophils as the different types of white blood cells.

  • Which white blood cells are typically elevated in pyogenic infections?

    -In pyogenic infections, bands and neutrophils (including CEGs) are typically elevated.

  • What conditions are associated with elevated eosinophil levels?

    -Elevated eosinophil levels are associated with allergies, parasitic infections, and coccidioidomycosis (a fungal infection).

  • What is a 'left shift' in the context of WBC count?

    -A 'left shift' refers to the increased presence of bands (immature neutrophils) in the blood, which is typically seen in response to bacterial infections.

  • How can the use of steroids affect WBC count?

    -The use of steroids can cause leukocytosis due to demargination (white blood cells moving from the vessel walls to the center), delayed migration (cells not moving into tissues), and to a lesser extent, band release from the bone marrow.

  • What are the 'big four' causes of leukocytosis mentioned in the script?

    -The 'big four' causes of leukocytosis mentioned are infection, steroids, cancer/leukemia, and catastrophic events.

  • How can one differentiate between leukocytosis caused by steroids and that caused by infection?

    -Leukocytosis caused by steroids usually involves a proportionate increase in all types of white blood cells without a left shift, whereas infection often causes a significant increase in bands and may not show a proportionate increase across all cell types.

  • What is the significance of a very high WBC count in the context of Clostridium difficile colitis?

    -A very high WBC count (30 to 40 to 50 x 10^9/L or higher) can indicate a severe infection such as Clostridium difficile colitis, which may require imaging and specific treatments like oral vancomycin and metronidazole.

  • What is the role of leukocyte alkaline phosphatase (LAP) score in differentiating between leukocytosis caused by infection and leukemia?

    -The LAP score indicates the amount of leukocyte alkaline phosphatase within the cells. A low LAP score in the presence of high leukocytosis suggests leukemia, while a high LAP score suggests an appropriate amount of LAP, likely due to infection.

  • How can catastrophic events affect WBC count?

    -Catastrophic events like myocardial infarction, cardiac arrest, or massive pulmonary embolism can cause a transient increase in WBC count due to the stress they impose on the body.

Outlines
00:00
🔬 Introduction to Leukocytosis and WBC Counts

The first paragraph introduces leukocytosis, an increased white blood cell (WBC) count, often seen in hospital or outpatient settings. It covers the normal WBC range (4.5 to 11 billion cells per liter) and notes that anything above 11 indicates leukocytosis. The importance of monitoring trends is emphasized, as changes in WBC count can indicate different stages of a condition. The paragraph also introduces the concept of different white blood cells, such as neutrophils, lymphocytes, monocytes, and eosinophils, each with their specific roles and associated conditions.

05:01
🦠 Identifying Causes of Increased WBC

This paragraph discusses various causes of elevated WBC counts and how to identify them. It highlights the importance of clinical signs such as fever and pain in diagnosing infections. Diagnostic tests like chest X-rays, urinalysis, and CT scans are recommended for confirming infections. The paragraph also covers the impact of steroids on WBC counts, explaining mechanisms like demargination and delayed migration. Steroids can cause a modest increase in WBC count, but a significant rise could indicate an underlying infection.

10:04
💉 Leukemia and Catastrophic Events

The final paragraph explores how leukemia, lymphoma, and catastrophic events can cause leukocytosis. Different types of leukemia, such as acute and chronic lymphocytic and myelogenous leukemias, are mentioned, along with their specific WBC patterns. The concept of leukocyte alkaline phosphatase (LAP) score is introduced, used to differentiate between cancer and other causes of elevated WBC. The paragraph also explains how stress from events like myocardial infarction, cardiac arrest, or surgery can temporarily increase WBC counts, followed by a return to normal levels. Other causes, including cold showers, are briefly mentioned.

Mindmap
Keywords
💡Leukocytosis
Leukocytosis refers to a condition characterized by an abnormally high white blood cell (WBC) count in the blood, typically above 11 x 10^9/L. In the video, leukocytosis is the central theme, as it is discussed in various contexts such as infection, steroid use, and other causes. The script mentions that leukocytosis can be seen in both inpatient and outpatient settings and emphasizes the importance of monitoring trends rather than isolated values.
💡White Blood Cells (WBC)
White blood cells, or leukocytes, are a crucial part of the immune system and are the focus of the video. WBCs include different types of cells such as neutrophils, lymphocytes, monocytes, eosinophils, and basophils, each with specific functions. The script explains that an elevated WBC count can indicate various conditions, including infections, and that the differential count helps identify the type of cells that are increased.
💡Differential
A differential count is a test that measures the proportion of different types of WBCs in a blood sample. The script explains that understanding the differential is essential for diagnosing the cause of leukocytosis, as different cell types can indicate different underlying conditions, such as bacterial infections or viral infections.
💡Neutrophils
Neutrophils are the most abundant type of WBC and play a key role in the body's defense against bacterial infections. The script mentions that an increase in bands and segmented neutrophils, collectively referred to as CEGs, is typically seen in pyogenic or bacterial infections, indicating the body's response to infection.
💡Lymphocytes
Lymphocytes are WBCs that are important for the immune response to viruses and other pathogens. In the script, lymphocytosis (an increase in lymphocytes) is associated with viral infections and is used as a clue to differentiate between bacterial and viral causes of leukocytosis.
💡Monocytes
Monocytes are large WBCs that can differentiate into macrophages, playing a role in the immune response to infections and the clearance of dead cells. The script notes that monocyte levels can be elevated in certain viral infections and tuberculosis.
💡Eosinophils
Eosinophils are involved in the immune response to parasites and allergic reactions. The video script highlights that an elevated eosinophil count should prompt consideration of allergies or parasitic infections, with a specific mention of coccidioidomycosis, a fungal infection.
💡Steroid Use
The script discusses how the use of steroids can lead to an increase in WBC count due to various mechanisms, such as demargination, delayed migration, and bone marrow release. This is important for distinguishing between leukocytosis caused by infection and that caused by steroid-induced changes.
💡Infection
Infections are a common cause of leukocytosis, as they trigger an immune response that includes the release of WBCs. The script provides examples of infections that can cause leukocytosis, such as pneumonia, urinary tract infections, and Clostridium difficile colitis, emphasizing the need for diagnostic tests to identify the source of infection.
💡Leukemia
Leukemia is a type of cancer that affects the blood and bone marrow, leading to an abnormal production of WBCs. The video script mentions different types of leukemia, such as acute lymphocytic leukemia and acute myelogenous leukemia, as potential causes of leukocytosis and discusses the importance of lab tests like leukocyte alkaline phosphatase (LAP) score in diagnosing leukemia.
💡Catastrophic Event
A catastrophic event, such as a myocardial infarction or a massive pulmonary embolism, can cause a transient increase in WBC count due to the stress response. The script explains that this type of leukocytosis is usually temporary and resolves as the body recovers from the event.
Highlights

Introduction to leukocytosis and its definition as a white blood cell count (WBC) higher than the normal range of 4.5 to 11 x 10^9/L.

Importance of monitoring WBC trends rather than single values to assess a patient's condition.

Explanation of white blood cells as part of the immune system, including different types like bands, segmented neutrophils, lymphocytes, monocytes, and eosinophils.

Elevated bands and neutrophils typically indicate pyogenic or bacterial infections.

Lymphocytes elevation is more typical for viral infections and certain conditions like tuberculosis.

Monocytes can be elevated in tuberculosis and certain viral infections.

Elevated eosinophils suggest allergies, parasites, or the fungal infection coccidioidomycosis.

Differentiation of white blood cells and their typical percentages in a normal CBC.

Significance of deviations in white blood cell differential percentages as indicators of specific conditions.

Causes of leukocytosis including infection, steroids, cancer/leukemia, and catastrophic events.

Infection causing a 'left shift' in white blood cells, indicating the release of bands from the bone marrow.

Use of diagnostic tests like chest X-ray and urinalysis to confirm suspected infections.

Steroids causing WBC increase through mechanisms like demargination, delayed migration, and bone marrow release.

Differentiation between steroid-induced leukocytosis and infection based on the presence of bands.

High WBC counts as a sign of Clostridium difficile colitis, requiring specific treatments.

Leukemia and lymphoma as causes of leukocytosis due to abnormal white blood cell production or survival.

Leukocyte alkaline phosphatase (LAP) score as a diagnostic tool to differentiate between infection and leukemia.

Peripheral smear and pathologist review for atypical cells in suspected leukemia cases.

Catastrophic events causing transient increases in WBC due to systemic stress.

Variety of factors that can cause leukocytosis, including even a cold shower.

Transcripts

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LeukocytosisWBC CountMedCramInfectionsDiagnosticsHealthcareSteroidsLeukemiaHospitalPatient Care