Chronic idiopathic neutrophilia: experience and recommendations.

Weir AB, Lewis JB, Arteta-Bulos R
South Med J. 2011 104 (7): 499-504

PMID: 21886049 · DOI:10.1097/SMJ.0b013e31821ec7cc

OBJECTIVES - To distinguish chronic idiopathic neutrophilia (CIN) in a cost-effective manner from neutrophilia caused by important underlying illnesses.

METHODS - This was a retrospective review of patients visiting a Veterans Affairs Medical Center over the last 10 years with a diagnosis of leukocytosis or myeloproliferative disorder. Of this group, fifty-seven patients from 1999 to 2008 were identified with CIN. Clinical and laboratory parameters were examined to identify CIN and establish its course. Eighty-one patients who presented from 2005 to 2010 with myeloproliferative disorders were also studied at time of diagnosis to determine any possible confusion with CIN.

RESULTS - The patients with CIN were followed for a mean of ≥ 7.3 years without progression to other serious disorders. Compared to non-CIN patients evaluated for neutrophilia, in multiple logistic regression analyses, smoking (P = .001) and increased BMI (P = .004) were significantly associated with CIN. No CIN patient developed a clinically apparent myeloproliferative disorder other than chronic myeloid leukemia (CML). Of the patients with myeloproliferative neoplasms reviewed at the time of their initial diagnosis, only CML occasionally presented with a picture consistent with CIN. For nonsmokers, the BMI of CIN patients was significantly higher than the average VA population (P < .001).

CONCLUSION - Cigarette smoking and obesity are confirmed as factors associated with CIN and may be causative. CIN is unlikely to develop into a clinically recognizable myeloproliferative neoplasm other than CML. Cost-effective guidelines for the diagnostic evaluation of neutrophilia in otherwise healthy patients are presented.

MeSH Terms (14)

Adult Aged Chronic Disease Female Humans Leukemia, Myelogenous, Chronic, BCR-ABL Positive Leukocytosis Logistic Models Male Middle Aged Neutrophils Obesity Retrospective Studies Smoking

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