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Extreme leukocytosis in patients presenting to a pediatric emergency department
L J Mazur1, M W Kline, M I Lorin
1Department of Pediatrics, University of Texas Health Science Center, Houston 77030.
Insights
Extreme leukocytosis in children, defined as white blood cell (WBC) counts of 35,000/microliters or higher, is rare but associated with serious illness and bacteremia in emergency department settings.
Area of Science:
- Pediatric Emergency Medicine
- Hematology
Background:
- Elevated white blood cell (WBC) counts are common in pediatric emergency departments.
- Defining extreme leukocytosis is crucial for identifying potentially serious conditions.
Purpose of the Study:
- To determine the frequency and clinical significance of high WBC counts (≥25,000/microliters) in children.
- To establish a threshold for extreme leukocytosis in a pediatric emergency setting.
Main Methods:
- Retrospective review of pediatric ED patients from February 1985 to December 1986.
- WBC counts ≥25,000/microliters were identified and compared to controls (15,000–25,000/microliters).
- Analysis of the incidence of serious disease and bacteremia associated with high WBC counts.
Main Results:
- 5.8% of pediatric ED patients had WBC counts ≥25,000/microliters; 1% had counts ≥35,000/microliters.
- 18% of patients with WBC counts ≥25,000/microliters had serious illness; 6% had bacteremia.
- 26% of patients with WBC counts ≥35,000/microliters had serious illness; 10% had bacteremia.
Conclusions:
- WBC counts ≥35,000/microliters in children presenting to the ED represent extreme leukocytosis.
- This level of leukocytosis, though infrequent, is linked to a higher prevalence of severe diseases and bacteremia.
Abstract:
We determined the frequency and clinical significance of white blood cell (WBC) counts greater than or equal to 25,000/microliters in children presenting to an emergency department (ED) and defined a degree of leukocytosis which might be considered extreme in this setting. Records of all patients seen in the ED between February 1985 and December 1986 with WBC counts greater than or equal to 25,000/microliters were identified. Each patient was paired with the chronologically nearest patient with a WBC count between 15,000 and 25,000/microliters. Of the total WBCs obtained, 5.8% were greater than or equal to 25,000/microliters; only 1% were greater than or equal to 35,000/microliters. Eighteen percent of patients with counts greater than or equal to 25,000/microliters had a serious disease, and 6% had bacteremia. Twenty-six percent of patients with counts greater than or equal to 35,000/microliters had a serious disease, and 10% had bacteremia. On the basis of infrequency and severity of illness, we suggest that, in children presenting to a pediatric emergency department, WBC counts greater than or equal to 35,000/microliters be considered extreme leukocytosis.