First, review the patient’s complete blood count (CBC) with differential. A prednisone-induced WBC elevation typically shows a neutrophilia, often exceeding 12,000 cells/µL. Lymphopenia may also be present.
Next, consider the timing of the WBC elevation. It usually appears within days to weeks of starting prednisone, correlating with dosage and duration of therapy. A sharp rise immediately after initiation strongly suggests a prednisone effect.
Then, explore other potential causes. Rule out infections through cultures and clinical evaluation. Assess for other medications or underlying conditions that may cause leukocytosis.
Following this, carefully evaluate the clinical picture. A patient with a mild WBC elevation, no other symptoms, and a known indication for prednisone may not require further investigation. However, significant elevations or the presence of symptoms warrant a broader search for alternative diagnoses.
Finally, adjust the prednisone dose or consider alternative treatment options if the leukocytosis is severe, persistent, or accompanied by symptoms. Close monitoring is critical, with repeat CBCs as clinically indicated.
