51 year old male with ahistory of diabetes (recently well controlled), smoking who has persistent leukocytosis (14k – 16k) over last 5 months. Elevated driven by neutrophilia (~11k). Smear was unremarkable. No evidence of etiology for a reactive leukocytosis. Recent CMP normal. Other cell lines are normal (Hg, 15, Plts 160 – 300s). Had sent smear to look for abnormalities and repeated CBC which again showed neutrophilia and nothing abnormal on smear.
Can I send some additional labs to begin a workup of this? Or other tests? Or does he need to be seen by heme in person for BM biopsy, etc.