PURPOSE: Patients treated with corticosteroids are often found to have an increase in total white blood cell (WBC) count. The study was conducted to evaluate quantitative changes in total WBC, neutrophil, lymphocyte and eosinophil count following steroid administration in patients with asthma or COPD exacerbation.
METHODS: We retrospectively reviewed 100 cases admitted with diagnosis of COPD or asthma exacerbation between January 2002 and September 2005. Inclusion criteria: age 18 and older, steroids administered on admission (daily for atleast first 3 days), normal WBC count on admission and WBC count with differential count checked daily during first 3 hospitalized days. Exclusion criteria: patients with malignancy, autoimmune disease, HIV infection, fever on admission,chest X-ray suggestive of infectious process on admission and those who have been on chronic oral steroid treatment. Total WBC, neutrophil, lymphocyte and eosinophil counts during first 3 days following admission were recorded and compared by Bonferoni t-test.
RESULTS: The mean leukocyte count increased from 8.5 × 103(day1) to 9.7 × 103(day2), and to 14.4 × 103(day 3) (P< 0.0001). The mean neutrophil count increased from 5.3 × 103(day1) to 8.4 × 103(day2) and to 11.9 ×103(day3) (p < 0.0001). The mean lymphocyte count decreased from 2.1 × 103(day1) to 1.0 × 103(day2) (p< 0.0001), followed by an increase from 1.0 × 103(day2) to 1.7 × 103(day3) (p< 0.0005). The mean eosinophil count decreased from 0.5 × 103(day1) to 0.2 × 103(day2) and to 0.05 × 103(day3) (p< 0.0001).
CONCLUSION: The pattern of steroid induced changes in the total WBC, neutrophil, lymphocyte and eosinophil count is predictable during the first 3 days of initiation of treatment in absebce of active infection at the time of admission. The described changes can be used in evaluating complications, such as infections or non-responsiveness to treatment.
CLINICAL IMPLICATIONS: Awareness of a predictive response on total WBC and differential count following steroid administration can help to differentiate it from infection. Such approach can avoid unnecessary use of antibiotics.
DISCLOSURE: Chirag Pandya, None.