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  • Recent infection

    • reactive: usually viral (mono)
    • other infections: pertussis, cat scratch, toxo
    • drug reaction usually have eosinophilia
  • Chronic or severe

    • marrow bx if
      • monoclonal B cells
      • slg negative mature B cells
      • aberrant T cells (CD3 smear, significant CD7 loss)
      • increased blasts (in peripheral blood should be close to none)
    • moniter
      • no monoclonal B cell, aberrant T cell, or increased blast population
      • if clinical concern persists, a future repeat CBC may be considered
    • other possibilities
      • postsplenectomy (associated with neutrophilia)
      • thymoma