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Discussion

Steroid ques.

Orientees ask the hard stuff, don't they? :lol2:

Had a pt on prednisone whose WBC increased to 14. He asked me why and I wasn't sure...no documented infection, no leukemia. Just a bad case of COPD. He asked if it was the steroids. I mused that I thought steroids supressed the immune response and to my mind that should make a WBC lower. But the intensivist said no, the increase was due to the pred. So I learned something new, but now I want to know the physiology behind it. Any replies?

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I can give you part of the answer: prednisone causes your marginalized neutrophils to be released into the blood stream. Since they are a type of WBC, the total count will be higher.

I think (and I'm not totally sure, so don't quote me) the immune-suppressing effect of prednisone may cause the neutrophils to "think" their job is done, so they release themselves back into the bloodstream from the source of infection.

stresses on the body can also cause an increase in WBC

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Why not ask the intensivist who told you that?

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Oops, can't edit my last post.

Basically, steroid-induced leukocytosis is due to "demargination" - steroids make the WBCs that are stuck to vessel walls stop adhering to the walls and move into the bloodstream. So you get a higher number of total WBC in a blood sample, even though there aren't really more produced; it's an artificial increase.

I can give you part of the answer: prednisone causes your marginalized neutrophils to be released into the blood stream. Since they are a type of WBC, the total count will be higher.

I think (and I'm not totally sure, so don't quote me) the immune-suppressing effect of prednisone may cause the neutrophils to "think" their job is done, so they release themselves back into the bloodstream from the source of infection.

I have heard something similar to this from a doc in the hospital. He said that the prednisione breaks the "ligands". The ligands keep the neutrophils in place and when the "ligands" break, the neutrophils can go anywhere in the body for instance the blood stream and increase WBCs.

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