Leukemoid reaction

Leukemoid reaction - time significant increase in the number of leukocytes in response to any stimulus, accompanied by the appearance in the blood immature forms of white. The number of leukocytes in leukemoid reactions can reach 50 000 and more than 1 mm3 blood. Unlike leukaemia (see), with leukemoid reactions can detect the disease that caused it (infection, intoxication, malignant tumors, trauma of a skull , and so on); in punctate spleen no leukemic changes; the picture normal blood as the elimination of the underlying disease.

Leukemoid reactions - adverse reaction of blood, in which morphological blood picture is similar to leukemia or subleikemical paintings, but the pathogenesis of change varies.
The need to separately consider leukemoid reaction is determined by their quality characteristics, as noted in a laboratory study of blood, when laboratory doctor should emphasize known similarity in the blood picture with leukemia. To systematize the teachings on leukemoid reactions led to their differentiation from leukaemia. L. R. are a reflection of the functional state of the hematopoietic system, and the emergence of them often determined by individual reactivity of organism, although there is a group L. R., due to the specifics of the pathogen (infectious oligosymptomatic lymphocytosis, infectious mononucleosis).
In a basis of classification leukemoid reactions should be put first of all hematologic sign. However, in each particular case to establish the etiology L. R., which will give opportunity to eliminate the leukemia and apply rational treatment of the underlying disease. There are the following main types L. R.: 1) myeloid, 2) lymphatic and 3) lympho-monocytic.
Among L. R. myeloid type are the following subgroups. 1. L. R. with blood picture, typical for chronic myeloid leukemia. Etiology: infections - tuberculosis, dysentery, pneumonia, scarlet fever, erysipelas, purulent processes, diphtheria, lobar pneumonia, acute liver dystrophy, acute hemolytic crisis; ionizing radiation - radiation of x-rays, radioisotopes, etc.; shock - trauma, surgery, trauma of the cranium; intoxication - sulfa drugs, begomlem, carbon monoxide; receiving corticosteroids, Hodgkin's disease, metastases of malignant tumors in the bone marrow.
2. Leukemoid reaction eosinophilic type. Etiology: worm infestation (often tissue) - opisthorchiasis, fascioliasis, strongiloidoz, trichinosis and others; eosinophilic pneumonia (eosinophilic pulmonary infiltrates), allergic L. R. (antibiotics, medicinal dermatitis, heavy universal dermatitis, and so on); the so-called eosinophilic kollagenoz (illness Busse); allergic large eosinophilia unknown origin (duration 1 - 6 months), ending recovery; periarteritis nodosa.
3. Leukemoid reaction myeloblastic type. Etiology: sepsis, tuberculosis, malignant tumour metastases in bone marrow.
Among L. R. lymphatic and lympho-monocytic type are the following subgroups.
1. Lympho-monocytic reaction of blood. Etiology: infectious mononucleosis (specific virus).
2. Lymph reaction of blood. Etiology: oligosymptomatic infectious lymphocytosis (specific lymphotropic virus).
3. Lymph reaction of blood for various infections in children (giperlakotsitos). Etiology: rubella, whooping cough, chicken pox, scarlet fever, and lakemoy lymphocytosis (giperlakotsitos) in septic and inflammatory processes, tuberculosis and other
Gematologicheskij L. R. myeloid type are characterized by the following features: 1) blood picture is similar to subleikemical in chronic myeloid leukemia; in leucogramma prevail segmented and stab neutrophils and never increase the percentage of basophils; 2) unlike leukemia, more pronounced toxigenic grain of neutrophils; 3) punctata spleen (even if it is increased) and the lymph node is not marked signs of leukemia myeloid metaplasia; 4) in leukocytes no Ph' chromosome, characteristic myeloid leukemia; 5) the disappearance of reactions is connected with liquidation of the underlying disease.
Clinical symptoms L. p. not have; it refers to the main disease in which develop these reactions.
It should be noted the emergence leukemoid reactions on the ground of intoxication sulfa drugs and begomlem. Sulfa L. R. characterized by leukocytosis up to 20 000 with a shift of leucogramma to plasmic order has been revealed and promielozitov and anemia development; the duration is 2-3 weeks. Bogomolnyi L. R. usually come overdoses: blood picture subleikemical, anemia not, for short.
Leukemoid reaction from the action of ionizing radiation happen as a result of massive actions of ionizing radiation and are characterized by subleikemical the leucocytosis with a shift to the left until plasmic order has been revealed, and sometimes and eosinophilia. These reactions should be differentiated from these leukemias, developing under the influence of ionizing radiation at a later date.
Leukemoid reactions in malignant tumors can develop as a result of tumor products (political) on blood-forming organs. Common stomach cancer, metastatic lung cancer (cancer pneumonia, cancer lymphangitis) sometimes accompanied L. R. However, more often L. R. come as the result of irritation metastases granulocyte and eritropoeticescoe sprouts bone marrow.
Are observed: 1) subleikemical leukemoid picture with a shift to the plasmic order has been revealed and promielozitov; 2) myeloblastic leukemoid the blood picture, simulating acute leukemia (in the bone marrow of disseminated cancer); 3) more often erythroblast-granulocyte L. R.
Recently, in particular, often eosinophilic L. R. They are observed in a variety of diseases, and also at a combination of some diseases, usually not accompanied by significant changes in the blood, characteristic L. R.
It should be considered that the development of eosinophilic L. R. depends not only on the specificity of the etiological factor, but also the uniqueness of the reactivity of the organism of the patient.
In recent years there were some cases of cyclic febrile illnesses with small lymphadenopathy, and sometimes splenomegaly, which was accompanied by L. R. eosinophilic type (I. A. Cashiers). Indicators leukocytosis in these cases reach very large numbers - 50 000 - 60 000 1 mm3 percent eosinophils to 80-90. The disease is more, it is less difficult, the outcome is the same in all cases favourable. You can suspect infectious-allergic nature of this form. Busse describes a particular form of collagen disorders, accompanied by intense infiltration Mature eosinophils almost all organs and tissues of human body, eosinophilic L. R. blood, often spleno - and gepatomegalia, the defeat of the heart and lungs. This form differs progressive course, the prognosis for it is often poor. It is often mistaken for eosinophilic myeloid leukemia.
In tropical countries, there are cases of so-called tropical eosinophilia (not related to helminthic invasions). Expressed eosinophilic giperlakotsitos often occurs when the so-called drug disease. In addition, moderate or large eosinophilia with leukocytosis considered to be typical of some forms of periarteritis nodosa, bronchial asthma (especially in combination with various helminthic invasions), scarlet fever, and rheumatism. Once occurred eosinophilic leukemoid reaction (even temporary) are prone to recurrent and often re-appear under the influence of a variety of reasons after full normalization of blood.



The most difficulties to determine the cause L. R. with myeloblaste in the peripheral blood and the so-called reactive retikulez. There is an opinion hematologists that every kemoticonstheme or myeloblaste indicates leukemia, which sharply typisierte virtue of adherence to infection (sepsis, tuberculosis), and also in connection with the application for therapeutic purposes cytotoxic funds - antimetabolites. However, some pathologists are inclined to consider, obviously, the cases of kemoticonstheme and retikuleze as L. p. In these cases the leading role in the changes of the blood and blood-forming organs have tuberculosis, sepsis (complicated reactive retikulez), cancer. As shown theories say: historiemoralisk picture of the bone marrow - the presence of normal myeloid tissue, no diffuse proliferation of immature cells; in some cases, poverty cellular elements, among surviving cells lot plasma, there are some pockets of genocidalists places full aplasia with pockets of the regeneration of the reticular cells; characteristic leukemia metaplasia bodies no.
Leukemoid reaction lymphatic and monocyte-lymph-type are characterized by the similarity of peripheral blood with the picture of chronic lymphatic leukemia or acute leukemia. Such reactions occur as changes in blood at a completely separate disease - virus infectious mononucleosis, and viral oligosymptomatic the limfotsitoz.
On the pattern of blood L. R. when oligosymptomatic infectious limfotsitoz and symptomatic L. R. in whooping cough, chicken pox, rubella, scarlet fever identical. Leukocytosis usually reaches 30 000-40 000 and even 90 000-140 000. In leucogramma prevail usually lymphocytes, but detect a known percentage of microgeneration lymphocytes, atypical lymphocytes, reticular cells. When oligosymptomatic infectious limfotsitoz increased, the percentage of eosinophils and polysegmental of neutrophils.
The differential diagnosis from the blood picture in chronic lymphocytic leukemia should consider the existence of a large percentage of cells lacolina with leukemia and small their proportion in lakemedel the limfotsitoz; in addition, the lymph L. R. type of infectious limfotsitoz are children from 2-3 to 14-15 years, and chronic lymphocytic leukemia - persons older than 40 years. It is necessary to emphasize the rapid disappearance lakemedel limfozitoza - the number of leukocytes and the blood return to normal after 5 to 7 weeks.