Mechanism behind acute drop in WBC count

[Evil_Abed]

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Hey guys, quick question regarding something I saw recently on the wards. A patient we were consulted on was admitted to the MICU with signs and symptoms of sepsis. When I was digging through the chart, I saw that the patient's white count was around 14 on one day and pretty much 24 hours later, dropped down to around 3. I was wondering what the mechanism behind such an acute and precipitous drop in the white count is.

Some explanations I've come across when reading up on this:
-the cytokines and inflammatory mediators released due to bacteremia may cause neutropenia
-there may be sequestration of neutrophils in pulmonary tissue due to overwhelming bacteremia

I tried searching around and haven't come across an answer that made much sense to me, so I was wondering if anyone had an answer to why this sudden drop from leukocytosis to leukopenia might occur. I know sepsis can present with leukopenia (one of the SIRS criteria), but I'm more interested what causes the white count to swing so wildly in a matter of 24 hours because the patient initially presented with an elevated white count.

Thanks in advance!

 

[Carboxide]

Long story short: the extreme activation of the pro-inflammatory mediators (primarily IL1, IL6 and TNFalpha) causes a kind of 'rebound' anti-inflammatory mechanism to occur. The body freaks out about the huge amount of pro-inflammatory mediators and the associated vascular endothelial damage...so it release a (possibly excessive) cascade of anti-inflammatory mediators, such as IL-10 and IL-1RA. These are present in higher amounts in septic shock as opposed to sepsis.

Leukopenia is more common in late sepsis as opposed to early sepsis.

Does that help?