A high white blood cell count may be associated with an artificially low blood glucose level caused by the white cells metabolizing the glucose. One might wonder how many cases are missed, since only the widely discrepant patients are detected.
Situations where seen:
(1) leukemia
(2) myeloproliferative disorder
(3) leukemoid reaction
(4) leukocytosis following therapy with granulocyte colony stimulating factor (Neupogen, other)
Clinical manifestations:
(1) discrepancy between clinical and laboratory findings
(1a) asymptomatic hypoglycemia
(1b) diabetic symptoms but normoglycemia
(2) discrepancy between glucose readings done soon after collection and those for which processing or testing is delayed
Prevention:
(1) Collect the blood sample in a preservative such as sodium fluoride (60 mmol/L) that will reduce glycolysis.
(2) Rapid separation of serum from cells.
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