Evaluation of leukocytosis: Benign or malignant.

Abstract

245 Background: Hematologists frequently evaluate patients with leukocytosis to differentiate between benign and malignant causes. The objective of this quality improvement project was to identify risk factors for malignant leukocytosis. Methods: A retrospective analysis of 1,330 consults in ALM VA Outpatient Hematology Clinic between 1/1/2011 and 2/22/2015 was performed. 147 patients referred for evaluation of leukocytosis were included in this study. The following data was collected: sex, age, race, ethnicity, BMI, tobacco use, total WBC, tempo of leukocytosis (constant vs intermittent), Hg level, plt count, ANC, ALC, AMC, AEC, ABC, laboratory tests performed during work-up, final diagnosis (primary hematologic malignancy vs secondary causes). 35 patients (24%) with a diagnosis of primary hematologic malignancy were compared with 112 patients (76%) with secondary causes and the relative risk of a primary hematology malignancy related to various risk factors was calculated. Results: See Table. Conclusions: Statistically significant independent risk factors for the presence of a primary hematologic malignancy as the cause of leukocytosis were identified. There was no increased risk based on race, ethnicity, BMI, AMC, or AEC. By identifying risk factors for malignant leukocytosis, we have created and implemented an algorithm outlining clinically appropriate and cost-effective laboratory evaluation for patients with leukocytosis.[Table: see text]