Leukemoid Reaction in a Severe COVID-19 Patient

Abstract

Leukemoid reaction is defined by a leukocyte level above 50 x 10 3 /µL with a predominance of mature neutrophils and the presence of immature granulocytic forms in the peripheral blood (left shift). We report a case of a 36-year-old woman with severe coronavirus disease 2019 (COVID-19) infection admitted to the ICU with a leukocytosis of 70.9 x 10 3 /µL white blood cells (WBC) throughout her hospitalization. A left shift with bandemia along with toxic granulations was also noticed and further investigation excluded more commonly known causes. A presumptive diagnosis of leukemoid reaction was made secondary to COVID-19 infection; however, it could not be confirmed since workup for lymphoproliferative disorders could not be performed as the patient passed away. The leukemoid reaction could be associated with severe COVID-19 infection; however, more data are needed to evaluate this association.

Extreme Leukocytosis and Gangrenous Cholecystitis Associated with Cytoreductive Surgery and HIPEC-Treated Mucinos Ovary Cancer: Case Report and Literature Review

“…The presence of a leukemoid reaction in a COVID-19 patient with a severe clinical picture has been described in several cases, with a leukocyte range of 70.9-96.6 × 10 9 /L and with a fatal outcome in the period of 5-14 days from hospitalization [22].…”

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“…[13] Case reports on severe covid 19 patients showed rare findings of leukemoid reaction irrespective of age, and were associated with high mortality. [14,15]…”

Leukemoid Reaction With Severe Diabetic Ketoacidosis

“…It is a rare manifestation of stress or systemic inflammation that has been linked to both malignant and benign disease processes [ 2 ]. It is produced by inflammatory reactions or organic stress from a variety of causes, including infections, medications, intoxications, bleeding, and cancer [ 1 ]. When defining leukemoid reactions, the actual cut-off value for leukocytes might vary, with lower and higher levels also being used as a cut-off [ 3 ].…”

“…Leukemoid reaction is a clinical condition characterized by a significant increase in white blood cells ranging from 50,000 to 100,000 per mm 3 , mainly mature neutrophils, and immature granulocytic forms in the peripheral blood (left shift) [1]. It is a rare manifestation of stress or systemic inflammation that has been linked to both malignant and benign disease processes [2].…”