Leukocytosis steroid vs infection induced leukocytosis

Q: Leukocytosis is a known side effect of steroid treatment. What would be the best way to differentiate it from infection induced leukocytosis?

Answer: A left shift in total WBC count with more than 6 percent band forms is a good indicator of infection. Also, request can be made to lab to look for the appearance of toxic granulation which are rare in corticosteroid-induced leukocytosis.

#lab-medicine

Reference: 

Shoenfeld Y, Gurewich Y, Gallant LA, Pinkhas - Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis.- J.Am J Med. 1981 Nov;71(5):773-8.