22 July 2025
: Case report 
Leukemoid Reactions in Pancreatic Cancer: A Case Series
Challenging differential diagnosis, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Teng Huang BCDE 1, Tangchun Liu BCD 1, Siqi Liu BC 1, Zhengfei Yang AE 1*DOI: 10.12659/AJCR.948491
Am J Case Rep 2025; 26:e948491
Table 1 Clinical characteristics, diagnosis, treatment, and outcomes of patients with tumor-associated leukemoid reaction.
| Patient | Primary disease | Clinical manifestations and laboratory tests | Diagnosis | Treatment | Prognosis |
|---|---|---|---|---|---|
| Patient A, Male, 52-years-old | Pancreatic cancer with hepatic metastases | The patient presented with progressive abdominal distension, worsening jaundice, and fatigue. He had been diagnosed with pancreatic cancer over 6 months previously. On admission (10 October 2024), vital signs were: temperature 36.1°C, pulse 120/min, respiration 21/min, and blood pressure 115/87 mmHg. Laboratory tests revealed marked leukocytosis (WBC 96.22×10/L with 93% neutrophils), severe liver function impairment (ALT 438 U/L, AST 749 U/L), and severely compromised coagulation (PT 31.9 s, INR 2.91). Bone marrow biopsy demonstrated active myeloid hyperplasia without leukemic features, consistent with a tumor-associated leukemoid reaction | Condition deteriorated rapidly and he died on Day 3 of hospitalization due to multiple-organ failure | ||
| Patient B, Female, 60-years-old | Multiple metastases after surgery for left breast cancer | Substantial leukocytosis with hypoproteinemia. The patient had no fever but experienced fatigue, poor appetite, and generalized weakness. Mild jaundice and worsening abdominal distension were observed. Laboratory tests showed a WBC count of 52.82×10/L, 92.6% neutrophils, and elevated fibrinogen (5.59 g/L) | After treatment, the patient’s WBC count decreased. She was discharged in stable condition and followed up regularly | ||
| Patient C, Male, 59-years-old | Multiple metastases after combined treatment for splenic flexure colon cancer | Recurrent fever with cough and sputum production, fatigue, substantial loss of body mass and worsening generalized edema. Laboratory tests showed a WBC count of 54.98×10/L with 95.5% neutrophils, hemoglobin of 63 g/L, total bilirubin of 38.4 μmol/L, and D-dimer of 9.40 ng/mL | Condition deteriorated; treatment discontinued and patient died | ||
| Patient D, Male, 40-years-old | Cholangiocarcinoma with cirrhosis | Persistent fever with right upper abdominal distension and pain. The patient had a history of chronic liver disease and cirrhosis, with poor nutritional status. Laboratory tests showed a WBC count of 57.85×10/L, D-dimer of 3.87 mg/L, total bilirubin of 18.8 μmol/L, and albumin of 28.0 g/L | Condition deteriorated; treatment discontinued and patient died | ||
| Patient E, Male, 43-years-old | Postoperative recurrence of pancreatic cancer with liver metastases | The patient presented with abdominal pain, distention, loss of body mass, and worsening jaundice, with a history of tumor recurrence. Laboratory tests revealed a WBC count of 66.21×10/L with a marked increase in neutrophils, elevated fibrinogen (5.37 g/L), total bilirubin of 95.9 μmol/L, and hypercalcemia (2.86 mmol/L) | Condition deteriorated; treatment discontinued and patient died | ||
| WBC – white blood cell count; ALT – alanine transaminase; AST – aspartate transaminase; PT – prothrombin time; INR – international normalized ratio. | |||||