Neutrophilia

NEUTROPHILIA, an increase in the percentage of neutrophils in the blood; in this state, the total number of leukocytes is also more often increased, but it may be normal or even decreased. Neutrophilia is characteristic both for physiological (for example, digestive leukocytosis, especially after a protein-rich meal, leukocytosis of newborns, etc.) and for all pathological leukocytoses, infectious and inflammatory, toxic, etc. (see Leukocytoses, pathological leukocytoses). In clinical practice, neutrophilia is of great importance in infectious diseases, since in the majority of infectious diseases, neutrophilia occurs regularly, and only some of them proceed as a rule without neutrophilia (e.g., typhoid fever, chronic malaria); finally, in the same disease, depending on the severity of the latter, neutrophilia may be expressed differently or be absent altogether. Neutrophilia is observed in lobar and catarrhal pneumonia, epidemic cerebrospinal meningitis, actinomycosis (especially in chronic suppuration), rheumatic polyarthritis, septic processes, tuberculosis (mostly cavernous, complicated by secondary infection), Asiatic cholera, smallpox (in the initial and again in the pustular stage), chickenpox (usually without an increase or even with a decrease in the total number of leukocytes), epidemic parotitis (mostly not sharply expressed), whooping cough (in the catarrhal period), diphtheria, typhus (in the initial stage), scarlet fever, angina, measles (only in the first stage, later only with complications), tetanus, relapsing fever, malaria (during attacks), and often in lymphogranulomatosis. Neutrophilia is of no less importance in suppurative processes: empyema, peritonitis, perityphlitis, abscesses of the liver, lungs, purulent meningitis, etc. In these processes, neutrophilia often has great diagnostic and prognostic significance. Very often, by the degree of neutrophilic leukocytosis in appendicitis, one can judge the catarrhal or purulent nature of the process. Neutrophilia with a significant general increase in leukocytes, sometimes even without a characteristic general clinical picture, forces one to think about a suppurative process. Neutrophilia in diseases that usually proceed with lymphocytosis (e.g., typhoid fever, measles, in later stages, etc.) often points to complications by some inflammatory process. As for the prognostic significance of neutrophilia, with a very large general leukocytosis (> 40,000–50,000), both in general infectious and in suppurative processes, it usually serves as a poor prognostic sign; the same can be said about neutrophilia with a normal or even decreased total number of leukocytes if it is observed in suppurative and those infectious diseases which usually proceed with an increase in the total number of leukocytes (for example, lobar pneumonia, peritonitis). The diagnostic and prognostic significance of neutrophilia appears more clearly when taking into account not only the total number of leukocytes but also the character of the nuclear shift of neutrophils. (For details, see Leukocyte formula of the blood—neutrophilic leukocytosis.)