Discussion
Leukemoid reaction is an inflammatory stimulus originating outside bone marrow, that occurs due to causes like clostridium infection, disseminated tuberculosis, drugs (corticosteroids, lithium, colony-stimulating factors), neoplasm (carcinoma, sarcoma), and hemorrhage. It shows a close resemblance with CML, thus the patient requires tests like PBS, Bone marrow biopsy for exclusion of the alternate diagnosis. The course of her stay revealed the likely etiology of leukemoid reaction was due to severe hemorrhagic shock due to drain slippage with status TAH-BSO. The increasing trend of the cell counts demanded bone marrow aspiration finding that could not be performed because the patient left against medical advice. Failure to obtain BM and complete the management of the patient at the hospital is the limitation of the report. The detailed report of this rare case in our setting will help us deal with similar cases with a more evidence-based and systematic approach in future and hence the novelty lies within the detailed note of the case.
Similar to our findings, a case reported by Samaha G et. al, showed increasing titres of total count peaking to 78,000 with the finding of leukemoid reaction with thrombocytosis in a patient with severe hypovolemic shock with stage IV pancreatic cancer[11]. A prospective study done in 2019, showed that leukemoid reactions were mostly due to infections, severe bleeding, malignancy and medications.[12]
A cohort study conducted on Leukemoid reaction showed a majority of true leukemoid reactions were due to infection, neoplasms, and paraneoplastic reaction.[13] Case reports on severe covid 19 patients showed rare findings of leukemoid reaction irrespective of age, and were associated with high mortality.[14,15]