Clinical VignetteQuestion 1 of 23
White Cell Paradox
A 68-year-old woman with rheumatoid arthritis presents to the rheumatology clinic for routine follow-up. Three days ago, she was started on prednisone 60 mg daily for an acute disease flare. Today, she reports significant improvement in her joint symptoms. Her temperature is 37.0°C (98.6°F). Physical examination shows reduced synovitis in the metacarpophalangeal and proximal interphalangeal joints. No band forms are seen on peripheral blood smear. Laboratory studies show:
Two weeks ago:
Leukocyte count: 7,200/μL
Today:
Leukocyte count: 14,500/μL
Segmented neutrophils: 82%
Lymphocytes: 12%
Monocytes: 4%
Eosinophils: 2%
Which of the following mechanisms best explains the elevated leukocyte count?