Leukämoide Reaktion bei extrem unreifen Frühgeborenen

Abstract

Extremely immature preterm infants rarely present with a leukocytosis exceeding 30,000/microL. The pathogenetic sequence leading to leukemoid reactions in non-malignant diseases remains to be elucidated. Potential triggers for leukemoid reactions in premature infants include prenatal corticosteroids, chorioamnionitis and funisitis or systemic infection. In the two-year period from 2006 to 2007 all infants with a gestational age of less than 26 weeks were screened for leukocytosis. Among our cases, one preterm infant presented with a leukocyte count of 229,300/microL at the age of 48 hours, lasting throughout the first three weeks of life. Impairment of microcirculation and resulting organ dysfunction were not observed. Thus, invasive therapeutic procedures, which are routinely initiated in hyperleukocytosis in accompanying malignant diseases, may not have the same significance in extremely immature preterm infants and should be executed in these patients on an individual basis and with extreme caution.

Sepsis-induced Hyperleukocytosis in a Preterm

“…The exact etiology and mechanism are unknown, and a differential diagnosis is usually challenging. However, this can occur as a result of infections (Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Clostridioides difficile, and others), carcinomas, severe hemorrhage, following exposure to certain drugs, such as corticosteroids, and it also has been reported in preterm infants without any identifiable cause [7-9]. A negative CRP does not rule out the possibility of bacterial infection in children [10].…”

Extreme hyperleucocytosis of the premature

“…These various clinical presentations have been described in neonates with congenital leukaemia 19. In contrast, no short-term organ dysfunction has been observed in neonates with leukemoid reaction 2 15. However, several studies have shown that prematures with leukemoid reaction, compared with peers without leukemoid reaction, have an increased risk of developing a bronchopulmonary dysplasia.…”

“…We now know that chorioamnionitis and funisitis4 12 or perinatal infection13–15 are also causes of leukemoid reaction. The average length of this reaction is 1.5–32 days 2 6 9 15…”

“…Hyperhydration or invasive treatments such as leukopheresis or exchange transfusion may be necessary 17–19. On the other hand, in prematures presenting with a hyperleucocytosis owing to a leukemoid reaction, watchful waiting is justified according to the literature 2 15…”

An Unusual Presentation of Neonatal Sepsis as Hyperleukocytosis With Firm Lymphadenopathy: A Diagnostic Challenge

“…Hyperleukocytosis is the state where white blood cell counts are more than 100,000/cumm. The overall incidence of a leukemoid reaction is less in the newborn period (around 15%) [2,3]. Holland and Maurer in 1963 reported the first cases of a leukemoid reaction in neonates.…”