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25.04.2018 | Original Article | Ausgabe 7/2018

European Journal of Pediatrics 7/2018

Leukemoid reaction in the pediatric population: etiologies, outcome, and implications

Zeitschrift:
European Journal of Pediatrics > Ausgabe 7/2018
Autoren:
Assaf Hoofien, Havatzelet Yarden-Bilavski, Shai Ashkenazi, Gabriel Chodick, Gilat Livni
Wichtige Hinweise
Communicated by Peter de Winter

Abstract

Leukemoid reaction (WBC > 30,000/μL) may indicate significant medical conditions, mostly infectious. Prompted by the lack of population-based data on the presentation, characteristics, and necessary workup in children with leukemoid reaction, we searched the database of a tertiary pediatric medical center for all children presented with at least one WBC count of ≥ 30,000/μL in 2009–2014. Demographic, clinical, and laboratory parameters were recorded. Children admitted with WBC < 30,000/μL served as controls. Pneumonia was the most common diagnosis in the leukemoid reaction group, with a 5.5-fold higher prevalence of pleuropneumonia than in the control group. The leukemoid group had a longer average hospital stay (7.5 vs. 5.5 days). Patients with WBC ≥ 50,000/μL had a sixfold higher rate of leukemia than patients with a lower count. There was a significant association of leukemia with low platelet count, low levels of C-reactive protein, and high levels of uric acid and lactate dehydrogenase.
Conclusion: Children presented with a leukemoid reaction are at high risk of pneumonia, especially pleuropneumonia, and a long hospital stay. Those with WBC ≥ 50,000/μL have a sixfold higher risk of leukemia. For prompt diagnosis, clinicians should be aware of the variables associated with leukemia.
What is Known:
• Leukemoid reaction has been associated with infectious diseases.
• Leukemoid reaction at presentation in adults is correlated with high morbidity and mortality.
What is New:
• Children with leukemoid reaction are at high risk of pleuropneumonia.
• We did not observe increased mortality in children with a leukemoid reaction.

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