Leukocytosis >11 (Repeated)

Blood Smear AND History & EMERGENT REFERRAL Refer to Blasts on Smear Physical Exam  >4 Page Hematologist On-Call Algorithm Include nodes and

Myeloid Cells

Basophils

CONCERNING FEATURES CONCERNING FEATURES CONCERNING FEATURES » Count >2 or increasing, or persistent » Count >50 » Count >2 or increasing or persistent » Not explained by » Promyelocytes and myelocytes » Dysplasia YES » Dysplasia » Dysplasia YES » » Immature forms » » New organ damage » Anemia/thrombo-cytopenia » » NOT explained by infection, » Splenomegaly » NOT associated with acute infection or collagen vascular

NO NO NO

Consider Consider » Cancer Reactive Causes » drugs NO » Collagen VD YES e.g. Infection / , NO NO » YES » Chronic infection autoimmune, drugs esp. steroids » Allergies » Marrow recovery » Collagen Vascular Disease

Refer to Treat and Observe for recovery Refer to Hematology Treat and Observe for recovery

© 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 IF PERSISTENT Work-up for secondary causes »Immunization »Viral (eg. , 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.