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Steroids induce leukocytosis through the release of cells from bone marrow and the inhibition of neutrophil apoptosis. This effect typically occurs within the first two weeks of steroid treatment.
Leukocyte elevation is commonly used in the diagnosis of septic patients; however, this can be hard to discern in patients on concomitant steroid therapy.
A retrospective cohort study of adult patients presenting with fevers and a diagnosis of pneumonia, urinary tract infection, bacteremia, cellulitis, or COPD exacerbation was conducted to determine the maximal level of WBC within the first 24h of admission between patients on acute, chronic, or no steroid treatment.
Results: maximal WBC levels (p< 0.001)
· Acute steroid therapy: 15.4 ± 8.3 x 10 9/L
· Chronic steroid therapy: 14.9 ± 7.4 x 10 9/L
· No steroid therapy: 12.9 ± 6.4 x 10 9/L
An increase in WBC of 5 x 10 9/L can be found in acute and chronic steroid use when presenting with an acute infection and fever.
References
Frenkel A, Kachko E, Cohen K, Novak V, Maimon N. Estimations of a degree of steroid inducted leukocytosis in patients with acute infections. Am J Emerg Med. 2018;36(5):749-753.