Stress Leucogram

A stress leuocogram is a finding on a haematological test. It is characterised by a neutrophilia, monocytosis, lymphopaenia and eosinopaenia

A useful pneumonic to remember is SMILED, which stands for Segmented (neutrophils) and Monocytes Increased, Lymphocytes and Eosinophils Decreased.

What can this indicate

A stress leucogram can be completely normal as part of the stress response. It is caused by endogenous release of adrenaline/epinephrine which causes the release of cortisol from the adrenal cortex - this causes the haematological parameters to change. Adrenaline and then cortisol release can be triggered by pain, stress or excitement.

A stress leucogram can also be seen in Cushing's Disease (AKA hyperadrenocorticism) where there is a pathological increase in the amount of cortisol released endogenously, or via iatrogenic injection of exogenous corticosteroids.

How does it occur?

The glucocorticoid (whether endogenous or exogenous) causes a variety of affects on blood cells, including margination