Leucocytosis | Right Decisions

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Leucocyte count of more than 11X10⁹/L.

Causes vary widely, from a normal response to an acute infection through to a haematological neoplastic process.

Causes

Acute inflammatory response
Drugs: steroids, GCSF therapy
Smoking
Solid tumours
Haematological disorders: AML, CML, CLL, CMML, MPN

Assessment

History and careful assessment for reactive causes, including drug and smoking history.
Careful examination for adenopathy, organomegaly
Repeat FBC, differential white cell count and blood film examination
CRP, liver and renal profile
Urinalysis
Consider Chest X-Ray particularly in smokers or cases with chest symptoms

Who to refer

Cases that should be referred immediately for management

Suspected acute Leukaemia. The on-call haematologist will contact the primary care after reviewing the blood results and blood film from the sample obtained
New cases of CML presenting with high white cell count (>100) or symptoms suspicious of hyperviscosity (visual blurring / loss, persistent headache, thrombosis)
New cases of CLL presenting with features of active haemolysis or severe cytopenia

Urgent referral

Unexplained persistent leucocytosis; leucocytes >50
New cases of CML excluding those with the above features
New cases of CLL with bulky adenopathy or B-symptoms ( drenching night sweats, weight loss of >10% of body weight in 3 months, excess fatigue)
Unexplained leuco-erythroblastic peripheral blood film; the film will be reported and phoned to the referring practice.

Routine referral

Persistent leucocytosis of > 20
Monocytosis
Basophilia

Last reviewed: 01/10/2024

Next review date: 01/10/2026

Author(s): Muayed Lasebai, Ranjit Thomas, Paul Ames.

Version: 1.0