Overview
Leukemia-like reaction, also known as leukemia-like reaction, is a strong stimulation of the body by certain factors leading to a significant increase in white blood cells, peripheral blood can appear naive cells, much like leukemia. Usually the causative agent is clear, and the blood picture recovers after the primary disease is removed. There is no anemia or thrombocytopenia.
The majority of leukemia-like reactions only have changes in blood picture, rarely have changes in bone marrow picture, and the changes in blood picture are only limited to a certain cell series, and generally do not affect the erythrocyte series and megakaryocyte series, so it is not difficult to differentiate from leukemia.
Etiology
There are clear causes, such as infection, poisoning, tumor, hemorrhage, hemolysis, anaphylaxis, medication and so on.
Symptoms
The disease can be seen in all age groups, but it is more common in children, and there is no difference in the incidence between men and women. The disease is most often secondary to severe infections and fever, most often high fever, often with a clear focus of infection, or tumor patients without signs of infection and unexplained leukocytosis. Some patients have bleeding tendency due to the combination of disseminated intravascular coagulation (DIC), which is manifested as skin bleeding spots, bruises, nosebleeds, gum bleeding, excessive menstrual bleeding in female patients, and internal bleeding in severe cases. Some patients may have enlarged liver, spleen and lymph nodes, but most of them appear at the same time with the primary disease. Occasionally, there may be dizziness, headache, dyspnea and so on. Leukemia-like reactions due to allergy may also show allergic manifestations such as skin rash.
Examination
1. Blood test
The white blood cell count is obviously increased, most of them are >50×109/L, but usually <120×109/L, and there are also a few leukocytes that are not increased. Different types of leukocytes have abnormal morphology, cytoplasm is often toxic granules, vacuoles, nuclei are shrunken, split abnormally. The total number of red blood cells and hemoglobin content have no obvious changes, and the platelet count is normal or increased.
2. Bone marrow
In addition to active hyperplasia and left shift of nuclei, there are often toxic granules. Usually, there is no obvious abnormality in red lineage and megakaryocyte lineage.
3. Cytochemical staining
Neutrophil alkaline phosphatase activity and score are obviously increased.
4. Imaging examination
Ultrasound, CT, MRI can help to find out the enlargement of liver, spleen and lymph nodes; PET-CT is helpful to identify the metastasis of malignant tumors.
5. Other tests for primary disease
Such as tuberculin test (PPD), blood culture, condensation test, etc.
Diagnosis
1. There is a clear cause of the disease.
2. Tests to rule out leukemia, such as flow cytometry, chromosomal and genetic tests, are necessary.
3. Leukocytosis or (and) the presence of naïve cells, while red blood cells and platelets are generally normal, according to the cellular morphology is divided into the following types of leukemic reaction.
(1) granulocyte type: this type is the most common, can be seen in pneumonia, meningitis, diphtheria, tuberculosis and other serious infectious diseases, can also be seen in malignant tumors, bone marrow metastasis, organophosphorus pesticides or carbon monoxide poisoning, acute hemolysis or hemorrhage, serious injuries or burns and so on.
(2) Lymphocyte type: common in certain viral infections, such as chickenpox, rubella, infectious mononucleosis; also seen in whooping cough, tuberculosis and so on.
(3) Monocyte type: common in tuberculosis, cytomegalovirus infection, subacute bacterial endocarditis.
(4) Eosinophilic type: seen in parasitic infections, such as schistosomiasis, filariasis, malaria, echinococcosis (encapsulated disease) and so on.
Treatment
1. Mainly for the treatment of primary disease, as long as the treatment of primary disease is effective, leukemia-like reaction can disappear.
2. Strengthen symptomatic and supportive treatment.