Filgrastim Induced Severe Leukocytosis in Sepsis-Associated Leukopenia: A Case Repor
Sepsis-induced leukopenia occurs in critically ill patients and associated with negative clinical outcomes. A sixty years old patients with respiratory failure, decreased level of consciousness and pneumonia transferred to the intensive care unit. During intensive care stay patients developed late ventilator-associated pneumonia and severe neutropenia. Colony stimulating factor (filgrastim) was initiated for patients. Severe leukocytosis (leukocyte counts of 94000/mm3) was seen with no source of new infection was detected. After filgrastim discontinuation serum leukocyte counts returned to the normal limits with no sequel or complication. Although Hyperleukocytosis may increase the risk of thrombosis and pulmonary edema. Most cases of iatrogenic hyperleukocytosis are well tolerated with no complication.
Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. Bmj. 2016;353(i1585).
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016;315(8):801-10.
Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, Kurosawa S, Stepien D, Valentine C, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiological reviews. 2013;93(3):1247-88.
de Oliveira AJA, Cardoso CP, Santos FR, de Magalhaes Campos AP, Leite E, Stanislau JdASG, et al. Predictors of mortality in patients with severe sepsis or septic shock in the ICU of a public teaching hospital. Critical Care. 2013;17(4):P31.
Root RK, Lodato RF, Patrick W, Cade JF, Fotheringham N, Milwee S, et al. Multicenter, double-blind, placebo-controlled study of the use of filgrastim in patients hospitalized with pneumonia and severe sepsis. Critical care medicine. 2003;31(2):367-73.
Reilly JP, Anderson BJ, Hudock KM, Dunn TG, Kazi A, Tommasini A, et al. Neutropenic sepsis is associated with distinct clinical and biological characteristics: a cohort study of severe sepsis. Critical Care. 2016;20(1):222.
Bo L, Wang F, Zhu J, Li J, Deng X. Granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) for sepsis: a meta-analysis. Critical care. 2011;15(1):R58.
Throm MJ. A review of the pharmacology and pharmacotherapy of colony-stimulating factors. Journal of Infusion Nursing. 2008;31(5):295-306.
Snyder RL, Stringham DJ. Pegfilgrastim-induced hyperleukocytosis. Annals of Pharmacotherapy. 2007;41(9):1524-30.
Khan A, Yasin Z. Hyperleukocytosis Caused By Neulasta Complicated By Leukostasis Versus Asymptomatic Uncomplicated Hyperleukocytosis In AML. Two Cases and When To Leukapherese. Am Soc Hematology; 2013.
Hugo ZP, Perry MC, Steensma DP. Extreme leukocytosis in the 21st Century is often iatrogenic. Am Soc Hematology; 2008.