Monocytosis

If mononuclear cells stand out in showing an unusually elaborate nuclear structure with ridges and lobes and a wider cytoplasmic layer with very delicate granules (for characteristics see p. 46, for cell function, see p. 6), and this is in the context of relative (> 10%) or absolute monocytosis (cell count > 900/^l), a series of possible triggers must be considered (Table 12). If the morphology does not clearly identify the cells as monocytes, then esterase assays should be done in a hematological laboratory using unstained smears.

Table 12 Possible causes of monocytosis

Infection

Nonspecific monocytosis occurs in many bacterial infections during recuperation from or in the chronic phase of:

- Mononucleosis (aside from stimulated lymphocytes there are also monocytes)

- Listeriosis

- Acute viral hepatitis

- Parotitis epidemica (mumps)

- Chickenpox

- Recurrent fever

- Syphilis

- Tuberculosis

- Endocarditis lenta

- Brucellosis (Bang disease)

- Variola vera (smallpox)

- Rocky mountain spotted fever

- Malaria

- Paratyphoid fever

- Kala-azar

- Thypus fever

- Trypanosomiasis (African sleeping sickness)

Chronic reactive condition of the immune system, e. g., in:

- Autoimmune diseases

- Chronic dermatoses

- Regional ileitis

- Sarcoidosis

Paraneoplasm

- Large solid tumors

- Lymphogranulomatosis

Neoplasm

- Chronic myelomonocytic leukemia (CMML, p. 107)

- Acute monocytic leukemia (p. 100)

- Acute myelomonocytic leukemia (p. 98)

Autoimmune Endocarditis Lenta

Fig. 30 Reactive monocytosis and monocytic leukemia. a Reactive and neoplastic monocytes are morphologically indistinguishable; here two relatively condensed monocytes in reactive monocytosis are shown. b Whenever monocytes are found exclusively, a malignant etiology is likely: in this case AML M5b according to the FAB classification (see p. 100). Auer bodies (arrow). c Monocytes of different degrees of maturity, segmented neutrophilic granulocytes (1), and a small myeloblast (2) in chronic myelomonocytic leukemia (CMML, see p. 107).

Fig. 30 Reactive monocytosis and monocytic leukemia. a Reactive and neoplastic monocytes are morphologically indistinguishable; here two relatively condensed monocytes in reactive monocytosis are shown. b Whenever monocytes are found exclusively, a malignant etiology is likely: in this case AML M5b according to the FAB classification (see p. 100). Auer bodies (arrow). c Monocytes of different degrees of maturity, segmented neutrophilic granulocytes (1), and a small myeloblast (2) in chronic myelomonocytic leukemia (CMML, see p. 107).

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Responses

  • Anna-Liisa
    What re the diseases cause relative monocytosis?
    5 years ago

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