Mysterious Leukocytosis in Sickle Cell Disease

Patients with sickle cell disease (SCD) can present with both acute and chronic complications. The diagnosis of these potentially life threatening complications is dependent upon an interdisciplinary team approach and good communication.

We present two patients with SCD both with laboratory evidence of chronic hemolytic anemia. The first is a 39 year old female who presented with generalized fatigue, bilateral leg pain and hypoxia. The second case is a 26 year old female who presented with right leg pain secondary to a sickle cell pain crisis. During both admissions they were found to have unexplained worsening leukocytosis.

When working up hemolytic anemia additional labs to be ordered including LDH, haptoglobin, indirect bilirubin and a review of the peripheral blood smear looking for shistocytes in addition to the basic labs that include a CBC with differential and complete metabolic panel. At our institution CBCs are performed on the Sysmex® XE-5000.

Both of these cases reveal the need to carefully review laboratory data and to communicate with the laboratory when data does not look accurate to find out why.

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Author(s):

Sandra Mazzoni and Danielle Hummel-Johnston

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