Laboratory Data

1. Hemoglobin and platelets. Leukocytosis accompanied by anemia or thrombocytopenia suggests leukemia, although infection and certain medications can sometimes cause cytopenias with leukocytosis.

2. Blood smear and differential. Always examine the blood smear to look for malignant cells in a patient with leukocytosis. Atypical lymphocytosis often accompanies viral infection, particularly Epstein-Barr virus. Neutrophilia with bandemia suggests bacterial infection. Eosinophilia accompanies connective tissue disease, hypersensitivity, parasitic infection, or malignancy. Pertussis causes extreme lymphocytosis.

3. Urinalysis with microscopic analysis. WBCs, nitrates, or leukocyte esterase in urine indicate UTI.

4. LDH and uric acid. Elevated uric acid or LDH can accompany leukemia or lymphoma.

5. Cultures. Cultures of blood, urine, cerebrospinal fluid, throat, or stool are critical in diagnosing infection. Whenever possible, cultures should be obtained prior to antibiotic administration.

6. ESR and C-reactive protein. These studies are nonspecific and can be elevated in many situations causing leukocytosis. May be useful as a baseline to follow progression of patient's condition.

7. Thyroid function. Hyperthyroidism can sometimes cause leukocytosis.

8. Rheumatologic studies. ANA, rheumatoid factor, complement levels, and other, more specific, tests can point toward a rheumatologic diagnosis.

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