INTEGRATED MORPHOLOGIC AND AUTOMATED HEMATOLOGY ASSESSMENT OF EXTREME LEUKOCYTOSIS: A COMPARATIVE STUDY OF TWO PEDIATRIC CASES
5 affiliations
- 1Centro de Pesquisa Clínica do Hospital Universitário da Universidade Federal do Maranhão; Secretaria Municipal de Saúde de São Luís; São Luís, MA, Brazil
- 2Centro de Pesquisa Clínica do Hospital Universitário da Universidade Federal Maranhão; Hospital da Criança Dr. Odorico Amaral de Matos, São Luís, MA, Brazil
- 3Centro de Pesquisa Clínica do Hospital Universitário da Universidade Federal Maranhão, São Luís, MA, Brazil
- 4Hospital da Criança Dr. Odorico Amaral de Matos, São Luís, MA, Brazil
- 5Centro de Pesquisa Clínica do Hospital Universitário da Universidade Federal Maranhão (UFMA); Departamento de Farmácia da UFMA, São Luís, MA, Brazil
Abstract
Introduction: Extreme leukocytosis in infants poses a major diagnostic challenge because reactive and neoplastic conditions may present with similar leukocyte counts. Integrating automated hematology analyzer data with peripheral blood morphology may improve early diagnostic assessment. Objectives: To compare hematologic, morphologic, and scattergram findings in two infants with extreme leukocytosis, identifying laboratory features associated with reactive and presumptively neoplastic hematopoietic processes. Material and Methods: A descriptive comparative study was performed using clinical records, complete blood counts, inflammatory and biochemical markers, Sysmex XN-1000® scattergrams, and May-Grünwald-Giemsa-stained peripheral blood smears independently reviewed by hematology specialists. Both cases were analyzed using the same analyzer and identical smear preparation and review protocol. A two-month-old male presented with presumed pulmonary sepsis and a 11-month-old female with prolonged fever, pallor, and suspected acute leukemia. Bone marrow examination and immunophenotyping could not be performed because both patients died before transfer to a specialized oncology center. Results: The first patient developed progressive leukocytosis from 106,000 to 155,180/mm 3 within 28 hours, with hemoglobin 10.8 g/dL, platelets 519,000/mm 3 , lactate dehydrogenase 964 U/L, and markedly elevated C-reactive protein (17.73 mg/dL). Peripheral blood demonstrated neutrophilia with an orderly left shift, preserved granulocytic maturation, toxic granulation, cytoplasmic vacuolization, and no blasts or dysplasia. WDF scattergrams showing expansion of the granulocytic compartment were consistent with a severe leukemoid reaction secondary to systemic infection. The second patient presented with 166,810 leukocytes/mm 3 , hemoglobin 4.2 g/dL, platelets 25,000/mm 3 , lactate dehydrogenase 1,774.8 U/L, C-reactive protein 1.06 mg/dL, erythroblastemia (2,790/mm 3 ), absolute monocytosis (111,763/mm 3 ), and 7% circulating myeloid-appearing blasts. Peripheral blood morphology revealed dysplastic monocytes, while WDF/WNR scattergrams demonstrated loss of cluster definition and blast-related flags, strongly suggesting a presumptively neoplastic hematologic process. Discussion: Despite similar leukocyte counts, the hematologic profiles reflected distinct biological processes. Preservation of granulocytic maturation characterized the reactive response, whereas cytopenias, blasts, dysplastic monocytosis, erythroblastemia, and abnormal scattergrams indicated disrupted hematopoiesis. These findings emphasize the diagnostic value of integrating peripheral blood morphology with automated hematology analysis. Conclusion: Extreme leukocytosis alone did not distinguish reactive from presumptively neoplastic hematopoietic processes. Integrated interpretation of peripheral blood morphology, hematologic parameters, and automated hematology analyzer scattergrams provided clinically relevant diagnostic information. It may support the initial evaluation of critically ill pediatric patients when definitive investigations are delayed or unavailable.
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BibTeX
@article{camelo2026integrated,
title = {{INTEGRATED MORPHOLOGIC AND AUTOMATED HEMATOLOGY ASSESSMENT OF EXTREME LEUKOCYTOSIS: A COMPARATIVE STUDY OF TWO PEDIATRIC CASES}},
author = {Nivânia LISBOA CAMELO and Elda PEREIRA NORONHA and Gabriela ALVES BERNARDINO and Khalil LIMA DA COSTA MAIA DOS SANTOS and Erica LEMOS DOS SANTOS and Ingrid SILVA CARNEIRO DE ALMEIDA MIRANDA and Karla Nadinne ANDRADE DA SILVA and Raimundo Antonio GOMES OLIVEIRA},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106747},
url = {https://doi.org/10.1016/j.htct.2026.106747},
note = {CC BY},
}
RIS
TY - JOUR
TI - INTEGRATED MORPHOLOGIC AND AUTOMATED HEMATOLOGY ASSESSMENT OF EXTREME LEUKOCYTOSIS: A COMPARATIVE STUDY OF TWO PEDIATRIC CASES
AU - Nivânia LISBOA CAMELO
AU - Elda PEREIRA NORONHA
AU - Gabriela ALVES BERNARDINO
AU - Khalil LIMA DA COSTA MAIA DOS SANTOS
AU - Erica LEMOS DOS SANTOS
AU - Ingrid SILVA CARNEIRO DE ALMEIDA MIRANDA
AU - Karla Nadinne ANDRADE DA SILVA
AU - Raimundo Antonio GOMES OLIVEIRA
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106747
UR - https://doi.org/10.1016/j.htct.2026.106747
AB - Introduction: Extreme leukocytosis in infants poses a major diagnostic challenge because reactive and neoplastic conditions may present with similar leukocyte counts. Integrating automated hematology analyzer data with peripheral blood morphology may improve early diagnostic assessment. Objectives: To compare hematologic, morphologic, and scattergram findings in two infants with extreme leukocytosis, identifying laboratory features associated with reactive and presumptively neoplastic hematopoietic processes. Material and Methods: A descriptive comparative study was performed using clinical records, complete blood counts, inflammatory and biochemical markers, Sysmex XN-1000® scattergrams, and May-Grünwald-Giemsa-stained peripheral blood smears independently reviewed by hematology specialists. Both cases were analyzed using the same analyzer and identical smear preparation and review protocol. A two-month-old male presented with presumed pulmonary sepsis and a 11-month-old female with prolonged fever, pallor, and suspected acute leukemia. Bone marrow examination and immunophenotyping could not be performed because both patients died before transfer to a specialized oncology center. Results: The first patient developed progressive leukocytosis from 106,000 to 155,180/mm 3 within 28 hours, with hemoglobin 10.8 g/dL, platelets 519,000/mm 3 , lactate dehydrogenase 964 U/L, and markedly elevated C-reactive protein (17.73 mg/dL). Peripheral blood demonstrated neutrophilia with an orderly left shift, preserved granulocytic maturation, toxic granulation, cytoplasmic vacuolization, and no blasts or dysplasia. WDF scattergrams showing expansion of the granulocytic compartment were consistent with a severe leukemoid reaction secondary to systemic infection. The second patient presented with 166,810 leukocytes/mm 3 , hemoglobin 4.2 g/dL, platelets 25,000/mm 3 , lactate dehydrogenase 1,774.8 U/L, C-reactive protein 1.06 mg/dL, erythroblastemia (2,790/mm 3 ), absolute monocytosis (111,763/mm 3 ), and 7% circulating myeloid-appearing blasts. Peripheral blood morphology revealed dysplastic monocytes, while WDF/WNR scattergrams demonstrated loss of cluster definition and blast-related flags, strongly suggesting a presumptively neoplastic hematologic process. Discussion: Despite similar leukocyte counts, the hematologic profiles reflected distinct biological processes. Preservation of granulocytic maturation characterized the reactive response, whereas cytopenias, blasts, dysplastic monocytosis, erythroblastemia, and abnormal scattergrams indicated disrupted hematopoiesis. These findings emphasize the diagnostic value of integrating peripheral blood morphology with automated hematology analysis. Conclusion: Extreme leukocytosis alone did not distinguish reactive from presumptively neoplastic hematopoietic processes. Integrated interpretation of peripheral blood morphology, hematologic parameters, and automated hematology analyzer scattergrams provided clinically relevant diagnostic information. It may support the initial evaluation of critically ill pediatric patients when definitive investigations are delayed or unavailable.
SN - 2531-1379
SN - 2531-1387
ER -