LK. Gonzalez, S. Malhotra, M. Levine and E. Jacobson-Dickman (2017). Leukemoid Reaction in a Pediatric Patient With Diabetic Ketoacidosis. Pediatric emergency care, 33(8), e27-e29. https://doi.org/10.1097/PEC.0000000000000558

PubMed 26414639

[Abstract]
Herein, we report a case of a 12-year-old girl who presented with diabetic ketoacidosis and a leukemoid reaction. Although this association has been described in a few adult patients, pediatric cases have not been reported. A leukemoid reaction is commonly defined as an elevation in the white blood cell count greater than 50,000/μL in response to severe illness or stress other than hematologic malignancy; it is considered to be mediated by various hormones, cytokines, and factors that are released in response to inciting triggers, such as acidosis. As highlighted in our report, distinguishing a benign leukemoid reaction from a hematologic malignancy and even tumor lysis syndrome, particularly in a setting of diabetic ketoacidosis, is crucial to ensuring safe and efficacious therapeutic interventions.