Leukocyte Count and Intracerebral Hemorrhage Expansion

Stroke. 2016 Jun;47(6):1473-8. doi: 10.1161/STROKEAHA.116.013176. Epub 2016 Apr 21.


Background and purpose: Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may in turn play a role in hemostasis. We investigated whether admission leukocytosis was associated with reduced bleeding after acute ICH.

Methods: Consecutive patients with primary ICH were prospectively collected from 1994 to 2015 and retrospectively analyzed. We included subjects with a follow-up computed tomographic scan available and automated complete white blood cell count performed within 48 hours from onset. Baseline and follow-up hematoma volumes were calculated with semiautomated software, and hematoma expansion was defined as volume increase >30% or 6 mL. The association between white blood cell count and ICH expansion was investigated with multivariate logistic regression.

Results: A total of 1302 subjects met eligibility criteria (median age, 75 years; 55.8% men), of whom 207 (15.9%) experienced hematoma expansion. Higher leukocyte count on admission was associated with reduced risk of hematoma expansion (odds ratio for 1000 cells increase, 0.91; 95% confidence interval, 0.86-0.96; P=0.001). The risk of hematoma expansion was inversely associated with neutrophil count (odds ratio, 0.90; 95% confidence interval, 0.85-0.96; P=0.001) and directly associated with monocyte count (odds ratio, 2.71; 95% confidence interval, 1.08-6.83; P=0.034). There was no association between lymphocyte count and ICH expansion (odds ratio, 0.96; 95% confidence interval, 0.79-1.17; P=0.718).

Conclusions: Higher admission white blood cell count is associated with lower risk of hematoma expansion. This highlights a potential role of the inflammatory response in modulating the coagulation cascade after acute ICH.

Keywords: hematoma expansion; inflammation; intracerebral hemorrhage; leukocytes; monocytes; neutrophils.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Disease Progression
  • Female
  • Hematoma / blood
  • Humans
  • Intracranial Hemorrhages / blood*
  • Intracranial Hemorrhages / diagnostic imaging
  • Leukocyte Count*
  • Leukocytosis / blood
  • Leukocytosis / etiology
  • Male
  • Middle Aged
  • Monocytes
  • Neutrophils
  • Predictive Value of Tests
  • Retrospective Studies
  • Sex Factors
  • Tomography, X-Ray Computed