Leukocytosis During Steroid TherapyLow back pain is often treated with interventional pain procedures using local anesthetic and corticosteroids. Leukocytosis following a facet joint injection how long does steroid induced leukocytosis last rarely noticed, and most doctors would associate this phenomenon with infection after invasive procedure. To our knowledge, leukocytosis resulting from corticosteroid administration without infection has not been reported in the literature. There were no immediate complications. She felt the pain had been greatly relieved, and she was discharged home in good condition. One day after the injection, the patient began to experience stabbing headache.
Corticosteroid Induce Leukocytosis During the Pain Management | Pain Medicine | Oxford Academic
The white blood cell WBC count is a routine laboratory test that reflects the number of leukocytes or WBC distributed in the blood. It is evident that the neutrophils make up the greatest percentage of leukocytes and thus can have the greatest impact on changes in the WBC count. Neutrophils are also called polymorphonuclear leukocytes PMN because of the number of stages they go through during their life cycle.
They are initially released from the bone marrow as immature neutrophils that are characterized as having a nonsegmented, band like appearing nucleus. As such, these immature neutrophils are called "bands". An increase in the number of these immature neutrophils in circulation can be indicative of a bacterial infection for which they are being generated to fight.
This is known as the "left shift" seen in a WBC differential. These and other neutrophils can be found in several compartments in the body, but the two compartments that relate most to this newsletter are the marginal compartment those neutrophils attached to the endothelium of the blood vessel and the circulating compartment those circulating in the blood vessels along with other cells.
Understanding this information is critical for the proper assessment of an elevated WBC count, especially when glucocorticoids e. While glucocorticoids are used to inhibit inflammation and the immune response in certain clinical situations, their initiation may also cause an increase in the WBC count.
Since increases in PMNs can be associated with bacterial infections, the use of the WBC differential can be helpful at determining whether or not the increase in WBC count was from a bacterial infection or the initiation of glucocorticoids.
The initiation of glucocorticoids does not usually cause the same degree of a "left shift" that is normally associated with presence of a bacterial infection. Determining the cause of the WBC increase is especially important, and often more difficult, in the immunocompromised patient. What are main causes of steroid induced increases in the WBC count? The answer is a multifactorial culmination of the following biological effects of the glucocorticoids.
It is common for patients to reveal a leukocytosis increased WBC count within 24 hours of initiation of a glucocorticoid.
It is important for clinicians to be aware of this expected side effect and to understand the rationale for such an increase as well as appropriate interpretation of the labs given the patient's clinical condition. Keeping all of these things in mind will help clinicians avoid unnecessary medical work-up for other conditions and avoid patient exposure to additional drug therapy that is not warranted, such as intravenous antibiotics.
About Us Disclaimer Contact Us. Please enter text to search. As such, it is important for clinicians to consider these effects in order to properly assess the increase in WBC counts so that a new or underlying bacterial infection is not missed. Patients with glucocorticoid induced leukocytosis generally will not present with the typical "left shift" in the WBC differential seen during an acute bacterial infection, nor should they develop a fever or experience a worsening of clinical symptoms assuming that the initial treatments are appropriate for the condition being treated.
Explanation The white blood cell WBC count is a routine laboratory test that reflects the number of leukocytes or WBC distributed in the blood. The greatest effect is demargination of the neutrophils from the endovascular lining. As a result, when a lab is drawn via venipuncture from a patient to determine the WBC count, there will now be a greater number of circulating PMNs.
However, it is important to note that the total number of PMNs has not changed, just the percentage of PMNs residing in each compartment. Junqueira LC, Carneiro J. Junqueira LC, Caneiro J eds. Abramson N, Melton B. Influenced of dosage, method and duration of administration on the degree of leukocytosis. Regulation of L-selectin and CD18 on bovine neutrophils by glucocorticoids: L-selectin expression on polymorphonuclear leukocytes and monocytes in premature infants: Mechanisms of glucocorticoid-induced down-regulation of neutrophil L-selectin in cattle: Glucocorticoids inhibit apoptosis of human neutrophils.
Glucocorticoid treatment inhibits apoptosis in human neutrophils. Separation of survival and activation outcomes. A non-steady-state kinetic evaluation of the mechanism of cortisone-induced granulocytosis.