WBC evaluation

 Q: Neutrophilia associated with corticosteroids is usually accompanied by? (select one) 

 A) Monocytosis

B) Eosinophilia

Answer: A

Many times it may become difficult to determine the cause of leucocytosis in ICU particularly when steroids are on board. One of the key evaluations is to look at the other lineage of WBCs.

One of the examples is the presence of monocytosis. Reading it with other clinical scenarios may help tremendously. Neutrophilia with monocytosis can be present in many conditions such as varicella-zoster, bacterial endocarditis, malaria, typhoid fever, corticosteroids, and asplenia. Monocytosis has also been described as a biomarker for inflammatory bowel disease.

 Similarly, eosinophilia and/or basophilia with neutrophilia is common with allergy, helminths, and parasitic infections.

#Laboratory-medicine

#pharmacology

References:

Lynch DT, Hall J, Foucar K. How I investigate monocytosis. Int J Lab Hematol. 2018 Apr;40(2):107-114. doi: 10.1111/ijlh.12776. Epub 2018 Jan 18. PMID: 29345409.

2. Anderson A, Cherfane C, Click B, Ramos-Rivers C, Koutroubakis IE, Hashash JG, Babichenko D, Tang G, Dunn M, Barrie A, Proksell S, Dueker J, Johnston E, Schwartz M, Binion DG. Monocytosis Is a Biomarker of Severity in Inflammatory Bowel Disease: Analysis of a 6-Year Prospective Natural History Registry. Inflamm Bowel Dis. 2021 Mar 9:izab031. doi: 10.1093/ibd/izab031. Epub ahead of print. PMID: 33693659.