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Referral
Lymphocytosis
Scope
Lymphocytosis is a common finding.
Transient increases in the lymphocyte count (lymphocytosis) are usually due to acute infections e.g., viral infections, pertussis. If there is persistent lymphocytosis, consider these causes:
- Auto-immune conditions, e.g. rheumatoid arthritis
- Smoking
- Post splenectomy
- Monoclonal B-cell lymphocytosis (a clonal lymphocytosis similar to CLL but with clonal lymphocytes less than 5 x 109/L and without other features of CLL)
- Chronic Lymphocytic Leukaemia (CLL)
- Alternative low grade lymphoproliferative disorders (e.g. Follicular Lymphoma)
Signs and Symptoms
Look for:
- Clinical signs of infection or inflammation
- Lymphadenopathy or hepatosplenomegaly
- If well or mild symptoms, recheck white count in 1 to 2 months. Reactive lymphocytosis generally resolves within 2 months
- A stable increased lymphocyte count in an otherwise well person is unlikely to require treatment and does not always need further assessment
- Asymptomatic low grade lymphoproliferative disorders (including CLL) do not benefit from earlier treatment
Referral Criteria
Request a haematology assessment if lymphocytosis is associated with:
- rapidly rising lymphocyte count (i.e. more than 20 x 109/L and doubling time of less than 6 months) or blast cells present
- lymphadenopathy or hepatosplenomegaly
- anaemia, neutropenia, or thrombocytopenia
Referral Instructions
e-Referral Service Selection
- Specialty: Haematology
- Clinic Type: Not otherwise specified
- Service: DRSS-Western-Haematology-Devon ICB-15N
Referral Form
Pathway Group
This guideline has been signed off by NHS Devon.
Publication date: June 2016
