Transient atypical lymphocytosis in patients with emergency medical conditions

Lymphocytosis in older adults is unusual and frequently indicates chronic lymphocytic leukemia or other lymphoproliferative disorder. This report describes 73 patients, aged 43 to 93 years, who presented with emergency medical conditions and who had absolute lymphocytosis, with absolute lymphocyte counts ranging from 4.1 to 12.9 x 10⁹/L (4,100 to 12,900/mm³). The lymphocytosis was characterized morphologically by atypical lymphocytes and was transient, followed, in most instances, by a neutrophilia. Most of the patients presented with serious cardiac conditions; the remaining presented with other critical disorders including status epilepticus and traumatic injuries. The mortality rate was high (50%). The lymphocytosis in some patients was probably secondary to the administration of epinephrine. The lymphocytosis in those not receiving epinephrine may have represented a physiologic reaction to severe stress.