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Etiology of Leukemoid Reaction in Patients Undergoing Extracorporeal Membrane Oxygenation

Christian B Wells1, Michal J Sobieszczyk1, Joseph E Marcus1,2

  • 1Department of Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX 78234, USA.

Military Medicine
|September 27, 2024
PubMed
Abstract

Insights

Leukemoid reactions are uncommon in patients on extracorporeal membrane oxygenation (ECMO). These high white blood cell counts rarely indicate new infections, suggesting limited use for empiric antibiotics in ECMO patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Hematology

Background:

  • Nosocomial infections are a significant concern for patients requiring extracorporeal membrane oxygenation (ECMO).
  • Leukemoid reaction (WBC >50,000/µL) is linked to infections in some patient groups.
  • ECMO circuits activate inflammation, potentially reducing the specificity of leukemoid reactions for new infections.

Purpose of the Study:

  • To investigate the incidence and causes of leukemoid reactions in adult ECMO patients.
  • To determine the association between leukemoid reactions and new infections in this population.
  • To evaluate the utility of leukemoid reactions in guiding antimicrobial therapy for ECMO patients.

Main Methods:

  • Retrospective cohort study of adult ECMO patients (≥72 hours) from 2018-2022.
  • Analysis of maximum white blood cell (WBC) counts and clinical data for patients with leukemoid reactions.
  • Review of infectious evaluations, comorbidities, and treatments at the time of leukemoid reaction.

Main Results:

  • 15 out of 182 (8%) ECMO patients developed a leukemoid reaction (median WBC 53.94/µL).
  • Most leukemoid reactions were multifactorial, associated with known infections (73%), new thrombus (40%), or glucocorticoid use (27%).
  • Only one patient (7%) was diagnosed with a new infection (Acinetobacter baumannii bacteremia) during their leukemoid reaction.

Conclusions:

  • Leukemoid reactions are infrequent and multifactorial in ECMO patients.
  • Leukemoid reactions have low specificity for new infections in this cohort.
  • The findings suggest limited utility in initiating or broadening antibiotics based solely on leukemoid reactions in ECMO patients.

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