Impact of Single Dose Systemic Glucocorticoids on Blood Leukocytes In Hospitalized Adults

Abstract

Background: Glucocorticoids (GCs) may cause leukocytosis via several mechanisms. This study was conducted to examine the impact of a single dose of systemic GCs on total white blood cell count (WBC), absolute neutrophilic count (ANC), and absolute lymphocytic count (ALC) in hospitalized adults without bacterial infections. Methods: This retrospective cohort study was carried out in a university hospital. Hospitalized patients 18 years of age or older who received a single dose of a systemic GC were included. Baseline blood cell counts prior to GC administration were required for subjects to be included in the study. Glucocorticoids included in this study were oral or intravenous methylprednisolone and hydrocortisone and oral prednisone. Results: A total of 99 patients were included in the study. After the administration of a single GC dose, ALC began to drop significantly as early as the interval of 0 - <6 hours [median (IQR), 0.90 (0.60-1.10), P=0.011]. ANC increased significantly as early as the interval of 6 - <12 hours [median (IQR), 6.22 (4.45-7.33), P=0.049] and continued to be significantly increased from baseline up to 42 hours from GC administration. Total WBC counts significantly decreased in the 6 - <12 hours interval [median(IQR), 6.90 (5.15-8.85) P=0.03] and then increased significantly in the12 - <18 hours interval [median(IQR), 8.80 (6.50-11.95), P= 0.002]. This effect on total WBC count continued to be significant until the 36 - <42 hours interval [median (IQR), 10.55 (7.23-13.03), P<0.001] Conclusion: ANC, followed by WBC count increase significantly after a single dose administration of GC in hospitalized patients within 12 hours of a single GC dose. Variability in timing and extent of leukocyte and ANC elevation was seen. A decrease in WBC and ALC was seen within the first few hours of GC dose. High doses of GC and autoimmune disease were associated with greater elevation in WBC counts.