Dilutional leukopenia?

[sprin001]

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I had an attending who was adamant that dilution/hemoconcentration would not have an effect on WBC count. Any takers with substantial evidence either supporting or disclaiming this? Thanks

 

[gutonc]

Of course it will have some effect. But it will be minor. But honestly, who cares? In the absence of infectious complications or clear downtrending counts, a little leukopenia is likely the least of this persons issues.

 

[throw away]

I had an attending who was adamant that dilution/hemoconcentration would not have an effect on WBC count. Any takers with substantial evidence either supporting or disclaiming this? Thanks

I'm guessing that dilution has less effect on WBCs counts because they are already much less concentrated than RBCs and platelets in the blood. Therefore the difference of adding a couple liters wouldn't be nearly as noticeable with WBCs than, say, with RBCs which are a thousand times more concentrated. Thoughts?

 

[sprin001]

That's a start to a logical explanation. I'll continue to ask around and maybe run into hem/onc next month for their opinion. I'll update if I find anything new.

 

[DoctwoB]

I'm guessing that dilution has less effect on WBCs counts because they are already much less concentrated than RBCs and platelets in the blood. Therefore the difference of adding a couple liters wouldn't be nearly as noticeable with WBCs than, say, with RBCs which are a thousand times more concentrated. Thoughts?

Doesn't make sense to me. Hemodilution occurs because you add acellular fluid to blood, thus lowering the overall concentration of cells per unit volume. If you expand blood volume by 20% with saline, you would expect approximately a 20% drop in all blood cells, including WBCs, which would then gradually be corrected by homeostatic mechanisms.

Sorry to your attending, but saying WBCs can't be diluted like any other cell line doesn't pass the smell test. They may rebound faster due to speed of production and potentially sequestered sources like the spleen and LNs.

 

[gutonc]

Demargination is one of those things that everybody talks about but nobody ever sees.

 

[Instatewaiter]

Sorry to your attending, but saying WBCs can't be diluted like any other cell line doesn't pass the smell test. They may rebound faster due to speed of production and potentially sequestered sources like the spleen and LNs.

This from your vast clinical experience no doubt...

 

[JoeBailey]

Demargination is one of those things that everybody talks about but nobody ever sees.

Isn't demargination the primary mechanism of glucocorticoid induced leukocytosis?

 

[DoctwoB]

This from your vast clinical experience no doubt...

Don't need too much experience to know that diluting a substance with water lowers the initial substance's concentration. And in my admittedly limited 2 years on the wards, I've routinely seen dilutional effects on all cell lines.

Don't be the one to parrot dogma you've heard without evidence or at the very least a theoretical mechanism. We have enough of that in medicine already.

 

[Instatewaiter]

Don't need too much experience to know that diluting a substance with water lowers the initial substance's concentration. And in my admittedly limited 2 years on the wards, I've routinely seen dilutional effects on all cell lines.

Don't be the one to parrot dogma you've heard without evidence or at the very least a theoretical mechanism. We have enough of that in medicine already.

So it was vast clinical experience I see...

 

[Raryn]

To be honest, I've also chalked up a mild leukopenia to dilution, but only when all 3 cell lines were affected. And never when it lasted more than a couple days.