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]