Leukocytosis Leukocytosis >11 (Repeated) Blood Smear AND History & EMERGENT REFERRAL Refer to Blasts on Smear Physical Exam Lymphocytes >4 Page Hematologist On-Call Lymphocytosis Algorithm Include nodes and spleen Myeloid Cells Basophils Monocytes Neutrophils Eosinophils CONCERNING FEATURES CONCERNING FEATURES CONCERNING FEATURES » Count >2 or increasing, or persistent » Count >50 » Count >2 or increasing or persistent » Not explained by infection » Promyelocytes and myelocytes » Dysplasia YES » Dysplasia » Dysplasia YES » Anemia » Immature forms » Basophilia » New organ damage » Anemia/thrombo-cytopenia » Splenomegaly » NOT explained by infection, allergies » Splenomegaly » NOT associated with acute infection or collagen vascular disease NO NO NO Consider Consider » Cancer Reactive Causes » drugs NO » Collagen VD YES e.g. Infection / inflammation, NO NO » Infections YES » Chronic infection autoimmune, drugs esp. steroids » Allergies » Marrow recovery » Collagen Vascular Disease Refer to Hematology Treat and Observe for recovery Refer to Hematology Treat and Observe for recovery © Blood Disorder Day Pathways are subject to clinical judgement and actual practice patterns may not always follow the proposed steps in this pathway. Lymphocytosis Lymphocytosis >4 (Repeated) Concerning Features “Reactive” Lymphocytes Asymptomatic » Lymphocytes >30 Patient symptoms of infection or acute illness » Hgb <100 » Night sweats/ weight loss » Splenomegaly Flow Cytometry AND Flow Cytometry IF PERSISTENT Work-up for secondary causes »Immunization »Viral (eg. Hepatitis, CMV, EBV, adeno) »Bacteria »Drugs (eg. Steroids) Refer to Hematology »Autoimmune »Smoking »Endocrine (eg. Myxedema, Addison’s, hypopituitarism) Normal / Polyclonal Abnormal / Clonal » B Cells » T Cells » NK Cells Rule out secondary causes » Immunization » Viral (eg. Hepatitis, CMV, EBV, adeno) » Bacteria » Drugs (eg. Steroids) Refer to Hematology » Autoimmune » Smoking » Endocrine (eg. Myxedema, Addison’s, hypopituitarism) © Blood Disorder Day Pathways are subject to clinical judgement and actual practice patterns may not always follow the proposed steps in this pathway..