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    Lymphocytosis 2017

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    HafsahMalik
    This document provides guidelines for investigating and referring adult patients presenting with lymphocytosis. It defines lymphocytosis as a lymphocyte count greater than 5 x 109/L. Over 80% of lymphocytosis cases are incidental or related to acute viral infections or smoking. The main causes of lymphocytosis are discussed. Primary care physicians are advised to check for viral infections, smoking history, or chronic conditions. Referral criteria to hematologists are provided, including referral for lymphocyte counts greater than 10 x 109/L or associated with concerning symptoms. A flowchart outlines evaluation and referral pathways.

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    © All Rights Reserved
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    Lymphocytosis 2017

    Uploaded by

    HafsahMalik
    116 views3 pages
    This document provides guidelines for investigating and referring adult patients presenting with lymphocytosis. It defines lymphocytosis as a lymphocyte count greater than 5 x 109/L. Over 80% of lymphocytosis cases are incidental or related to acute viral infections or smoking. The main causes of lymphocytosis are discussed. Primary care physicians are advised to check for viral infections, smoking history, or chronic conditions. Referral criteria to hematologists are provided, including referral for lymphocyte counts greater than 10 x 109/L or associated with concerning symptoms. A flowchart outlines evaluation and referral pathways.

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    Lymphocytosis explained

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    This document provides guidelines for investigating and referring adult patients presenting with lymphocytosis. It defines lymphocytosis as a lymphocyte count greater than 5 x 109/L. Over 80% of lymphocytosis cases are incidental or related to acute viral infections or smoking. The main causes of lymphocytosis are discussed. Primary care physicians are advised to check for viral infections, smoking history, or chronic conditions. Referral criteria to hematologists are provided, including referral for lymphocyte counts greater than 10 x 109/L or associated with concerning symptoms. A flowchart outlines evaluation and referral pathways.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    116 views3 pages

    Lymphocytosis 2017

    Uploaded by

    HafsahMalik
    This document provides guidelines for investigating and referring adult patients presenting with lymphocytosis. It defines lymphocytosis as a lymphocyte count greater than 5 x 109/L. Over 80% of lymphocytosis cases are incidental or related to acute viral infections or smoking. The main causes of lymphocytosis are discussed. Primary care physicians are advised to check for viral infections, smoking history, or chronic conditions. Referral criteria to hematologists are provided, including referral for lymphocyte counts greater than 10 x 109/L or associated with concerning symptoms. A flowchart outlines evaluation and referral pathways.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Uncontrolled when printed

    Southern Derbyshire
    Shared Care Pathology Guidelines

    Lymphocytosis in Adults

    Purpose of Guideline

    Investigation and referral guidelines for adult patients with lymphocytosis.

    Definition

    The normal range for the Absolute Lymphocyte Count is age related.

    In adults the normal range is 1.5 – 3.5 x 109/L

    Lymphocytosis is defined as a lymphocyte count > 5 x 109/L

    What are the main causes of lymphocytosis?

    Over 80% of patients have lymphocytosis as an incidental finding on a routine full


    blood count for unrelated symptoms or as part of health screening.

    • Transient, reactive lymphocytosis is frequently seen in acute self-limiting viral


    infection, particularly infectious mononucleosis, and in smokers.

    • Chronic infections like tuberculosis, brucellosis, secondary syphilis

    • Leukaemia and occasionally lymphoma. Chronic lymphocytosis is


    characteristic of chronic lymphocytic leukaemia, the incidence of which peaks
    between 60 and 80 years of age. In its early stages this condition is frequently
    asymptomatic and treatment is only required in significant progression which
    is about 1% per year.

    Please refer to the flowchart (see page 3).

    Investigations in primary care for patients with lymphocyte count >5 x 109/L:

    • Request glandular fever screen if appropriate.


    • History of recent viral infection
    • Smoking history, chronic infection/inflammatory condition.
    • Repeat FBC and blood film 6 weeks post viral infection and after quitting smoking.
    If lymphocytosis persists, blood film will be reviewed by a consultant
    haematologist with a comment suggesting further action.
    • Unexplained lymphocyte count of 5 - 10 x 109/L and otherwise well: monitor FBC
    6 monthly.

    CHISCP28: Lymphocytosis in Adults, Revision No 3


    st
    Expiry Date: 31 August 2019
    Author: Dr Sangam Hebballi, Consultant Haematologist, RDH Page 1 of 3
    Uncontrolled when printed

    Criteria for non-urgent referral to Haematologists:

    • Lymphocyte count of >10 x 109/L, and otherwise well

    Criteria for urgent referral to Haematologists:

    • Lymphocytosis in association with:


    o Hb<10g/dl or/and platelet <100 x 109/L
    o B symptoms
     weight loss >10% in previous 6 months
     severe night sweats
     unexplained fever of >38oC for >2 weeks
    o Lymphadenopathy
    o Hepatomegaly or Splenomegaly or both
    o Extreme fatigue

    Discussion with the duty haematologist:


    • Lymphocytosis with history of acute severe illness, bruises

    Contacts

    Mon to Fri (9am – 5pm): Haematology secretaries 01332 787973


    Out of hours: Duty Haematologist (via switchboard) 01332 340131

    Author: Dr Sangam Hebballi, May 2013

    Reviewed by: Date: Expiry date:


    Dr S Hebballi, Dr P Blackwell, Mrs H Seddon August 2015 31st August 2017
    Dr S Hebballi, Dr P Blackwell, Mrs H Seddon August 2017 31st August 2019

    CHISCP28: Lymphocytosis in Adults, Revision No 3


    st
    Expiry Date: 31 August 2019
    Author: Dr Sangam Hebballi, Consultant Haematologist, RDH Page 2 of 3
    Uncontrolled when printed

    Lymphocytosis Reactive? Treat underlying


    >5 x 109/L Cigarette smoking cause
    Chronic infections

    If yes, repeat FBC & Film in 6 weeks


    Unexplained weight loss >10% Viral
    Drenching night sweats No Infection? Check LDH, B2M, Protein electrophoresis
    Unexplained fever and refer if any abnormal
    Lymphadenopathy
    Hepatomegaly
    Splenomegaly
    Extreme fatigue Persistent Lymphocytosis?
    Patient Well?

    Yes
    Unwell
    Febrile
    Bleeding
    Bruising Lymphocytes >10 x 109/L Lymphocytes >5 x 109/L Lymphocytes 5 – 10 x 109/L
    and/or Haemoglobin <10g/dl and otherwise well
    and/or Platelets <100 x 109/L

    Urgent Urgent
    Referral Monitor FBC
    Referral Admission
    Required Referral 6 monthly
    Required Required
    Required

    CHISCP28: Lymphocytosis in Adults, Revision No 3


    st
    Expiry Date: 31 August 2019 B2M = Beta 2 microglobulin
    Author: Dr Sangam Hebballi, Consultant Haematologist, RDH Page 3 of 3

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