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Leukocytosis in labor: what are its implications?

OBJECTIVE: The objective of this study was to determine the usefulness of the peripheral white blood count (WBC) drawn during labor as a predictor of postpartum morbidity. METHOD: Hospital charts on 309 consecutive obstetrical deliveries performed by residents of the Cox Family Practice Residency were reviewed for evidence of maternal or neonatal postpartum morbidity. An analysis of means was used to compare the average antepartum WBC in the morbid and non-morbid groups. RESULTS: The average WBC in a laboring patient was 12,450, with a range of 4,400 to 29,100. Patients with postpartum complications had a WBC similar to that of patients without complications (12,900 vs 12,300 p = 0.449). CONCLUSION: An elevated WBC obtained on admission to the labor ward is not helpful in predicting postpartum complications in mothers or newborns.

Adolescent↗

[Tobacco and leukocytosis].

Six heavy smokers with leucocytosis are described. Except for leucocytosis, laboratory tests were normal. A strong tobacco-induced leucocyte response indicates an increased risk of developing arterial diseases and lung diseases.

Adult↗

Fever, leukocytosis, and referred thigh pain.

The patient, a 43-year-old man with insulin-dependent diabetes mellitus, presented four days after sustaining a dog bite on his right hand, complaining of excruciating, intermittent, right thigh pain. He was febrile (temperature, 38.3 degrees C [101 degrees F]) and had a leukocyte count of 27.8 x 10(9) per liter (27,800 per mm3). On physical examination, he had a 2-cm open wound with minimal purulent drainage on the fourth digit of his right hand. He had some limited range of motion of the right hip and focal muscular tenderness in the medial thigh, but no other infectious or neurologic findings. A radiographic evaluation included chest, lumbar, right femur, and pelvic films and a computed tomographic (CT) scan of the abdomen; all were normal. In addition, a nuclear medicine scan showed no signs of infection. A CT scan and a magnetic resonance image (MRI) of the pelvis were done (Figures 1 and 2).

Adult↗

Genetic influences determining progenitor cell mobilization and leukocytosis induced by granulocyte colony-stimulating factor.

The mechanisms involved in the mobilization of progenitor cells into the blood by granulocyte colony-stimulating factor (G-CSF) and other cytokines are poorly understood. To identify important influences on this complex process, in vivo murine models were used. Granulocyte-macrophage colony-stimulating factor (GM-CSF) transgenic, Max41 transgenic, W/Wv, Mpl-null, GM-CSF receptor (beta chain)-null mice, wild-type littermate controls, and six inbred strains of mice were injected with 200 microg/kg/d G-CSF for 5 days. Three parameters of response were monitored: white blood cell count (WCC), peripheral blood progenitor cell (PBPC) numbers, and spleen weight. In all genotypes studied, G-CSF induced increases in these three parameters. However, PBPC mobilization in W/Wv and Mpl-null mice was only 30% and 9%, respectively, of that observed in wild-type mice. In contrast, perturbations of GM-CSF signalling had no demonstrable effect on in vivo responses to G-CSF. Broad variability was evident between inbred strains for each parameter of the response to G-CSF. A 10-fold range in response was observed for circulating progenitor cell numbers, similar to that observed for normal human subjects receiving G-CSF. The interstrain differences were in the distribution of mature and progenitor cells between peripheral blood, bone marrow, and spleen rather than in the total numbers of these cells in the body. Results of an F2 intercross of low-responding C57BL/6 and intermediate-responding SJL mice indicated that regulation of progenitor cell mobilization is a complex genetic trait, that there is a correlation between this trait and WCC response (r2 = .5), and that this approach may serve as a useful model for the identification of genes involved in the mobilization process.

Animals↗