White Blood cell pathology (paediatrics)

White blood cell parameters

 * leukocytosis : > 10,000,
 * leukopenia : < 4,000,
 * neutropenia: < 1,000 (in children 2 weeks to 1 year), < 1,500 (in children over 1 year),
 * agranulocytosis: < 500,
 * lymphocytosis: > 5,000,
 * lymphopenia: < 1,500,
 * monocytosis: > 800 or > 10% in diff.,
 * eosinophilia: > 600 or > 10% in diff.,
 * basophilia: > 100 or > 1% in diff.

Differential diagnosis of leukocytosis and neutrophilia

 * pyogenic infection,
 * connective tissue disease
 * glomerulonephritis,
 * acidosis,
 * uremia,
 * acute bleeding,
 * hemolysis ,
 * burns,
 * surgery,
 * liver necrosis,
 * dehydration,
 * corticoids,
 * catecholamines,
 * lead and mercury poisoning,
 * bone marrow metastases.

Physiological causes of leukocytosis and neutrophilia

 * Stress,
 * physical exertion,
 * intense crying in a newborn,
 * smoking.

Leukemoid reaction
The leukemoid reaction represents a situation where we find several tens of thousands of leu/mm 3 + a significant shift to immature forms. Determination of ALP in neutrophils can help in differential diagnosis (in leukemia, ALP is reduced, in a leukemoid reaction as part of an infection or systemic disease, ALP is normal or increased). When in doubt, bone marrow aspiration brings certainty.

Differential diagnosis of lymphocytosis

 * Absolute lymphocytosis


 * infectious lymphocytosis,
 * infectious mononucleosis,
 * pertussis,
 * Syphilis,
 * TB,
 * hyperthyroidism.


 * relative lymphocytosis


 * measles,
 * exanthema subitum.

Differential diagnosis of neutropenia

 * congenital


 * reticular dysgenesis,
 * congenital pluripotent stem cell disorder,
 * m. Kostmann,
 * cyclic neutropenia,
 * Schwachmann sy.,
 * neutropenia during DMP: glycogenosis, m. Gaucher.


 * gained


 * isoimmune neonatal neutropenia,
 * vitamin B12 deficiency,
 * folic acid deficiency,
 * autoimmune etiology,


 * SLE ,
 * JIA ,
 * SCID ,
 * Hyper IgM syndrome,
 * Evans syndrome,
 * lymphomas,
 * drugs: chloramphenicol, antiepileptics, thyrostatics,
 * infection: EBV, CMV, HHV 6, HIV, Parvovirus, hepatitis, varicella, parotitis,


 * idiopathic neutropenia.

Differential diagnosis of eosinophilia

 * Allergic diseases,
 * skin diseases: atopic eczema,
 * parasitic infections: toxocariasis, oxyuria,
 * m. Hodgkin,
 * scarlatina.

Source

 * HAVRÁNEK, Jiří: Hematology - general introduction. (edited)

Related articles

 * Physiological and pathophysiological notes on pediatric hematology (pediatrics) • Neutropenia in children
 * Diseases of the white blood component :
 * Leukemia : Acute myeloid leukemia • Acute lymphocytic leukemia • Chronic myeloid leukemia • Chronic lymphocytic leukemia
 * Malignant lymphoma : Hodgkin's lymphoma • Non-Hodgkin's malignant lymphomas
 * Histiocytosis
 * Diseases of the red blood component : Anemia • Polyglobulia