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DR Medhat MRCP

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Leukemoid reaction<br />

- Describes the presence of immature cells such as myeloblasts, promyelocytes and<br />

nucleated red cells in the peripheral blood.<br />

- This may be due to infiltration of the bone marrow causing the immature cells to be<br />

'pushed out' or sudden demand for new cells .<br />

• Causes<br />

Severe infection.<br />

Severe hemolysis.<br />

Massive hemorrhage.<br />

Metastatic cancer with bone marrow infiltration<br />

- A relatively common clinical problem is differentiating CML from a Leukemoid<br />

reaction:<br />

Leukemoid reaction<br />

High leucocyte alkaline phosphatase (LAP)<br />

Toxic granulation (Dohle bodies) in WBCs.<br />

Left-shift of neutrophils<br />

Chronic myeloid leukaemia<br />

Low LAP.<br />

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