Definition: Increase in neutrophils on FBC differential.
Neutrophilia is frequently ‘reactive’. Reactive causes may include infections (especially bacterial), smoking, medications (e.g. corticosteroids, GCSF), stress events (e.g. trauma, seizures, myocardial infarction, eclampsia etc.), autoimmune diseases or other inflammatory processes.
Haematological causes are possible with a significant persistent neutrophil increase over 1-2 months in the absence of underlying reactive cause. Blood film comments may show circulating immature forms eg myelocytes/nucleated red cells or aniso/poikilocytosis.
C.M & L.W 24-7-26
Who to refer:
Patients with significant persistent neutrophilia >15 after 4-6 weeks with any of the following:
- no obvious cause such as inflammation
- additional abnormalities on blood film comments, eg presence of myelocytes or nucleated red cells or significant poikilocytosis
- significant anaemia or thrombocytosis/thrombocytopenia
- blood count/film reported as suggestive of chronic myeloid leukaemia
- splenomegaly.
Who not to refer:
Transient neutrophilia or persistent mild neutrophilia <15. This is most likely caused by chronic inflammatory or infective processes.
May be associated with smoking.
How to refer:
SCI Gateway to the Department of Haematology at WGH or St John’s.
Primary care investigations
- FBC + film
- Biochemistry including renal function, liver function, LDH, calcium, albumin, urate
- CRP
- Check smoking history including e-cigarettes.
