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CELL COUNT IS 'ABNORMALLY NORMAL'

Q. Today, my doctor's assistant told me that my white blood cell count has been abnormally high since 1992 (when I became a patient of theirs). I knew in the past that it was high, but didn't realize how high and for how long until today. It seems my count in the past nine years has ranged from 12,300 to 15,400. This is abnormally high.

My doctors are puzzled and are settling on the explanation that I am just abnormally normal when it comes to my white blood cell count. Is this possible, or should I be concerned about disease and such?

- A.D.

A. It's quite possible that your high white blood cell counts are "abnormally normal," especially if your doctors have ruled out the usual causes of the high counts.

White blood cells (leukocytes or WBCs) function as part of the body's defense against infection and other foreign substances. Like other blood cells, WBCs are produced in bone marrow from precursor or stem cells.

To do their job, an adequate number of white cells must be produced in the bone marrow and be made available in the bloodstream to get to where they're needed. When either production or availability is reduced, or when the white cells are being destroyed too rapidly, the cell count goes down.

Too few white cells (known as leukopenia) as well as too many (known as leukocytosis) indicate a problem, although leukopenia is usually of more concern.

The normal circulating white blood count varies from person to person and with age. Adult white cell counts range from 4,000 to 10,000 per microliter of blood. So you can see that your counts are a little higher than the upper level of the "normal" range.

Incidentally, it might be a good idea to ask your doctor for copies of all your test results (not just white count results) so you will be able to follow what's "normal" for you.

Leukocytosis is a common blood test finding, and is usually but not always a short-term finding. It's usually caused by a relatively benign condition like an infection or inflammation.

White cell counts usually go up with an infection, but the count may actually be lowered during part of the illness as the white cells are destroyed by the infection faster than they can be replaced. And even if there are enough white cells, if they do not function normally, such as in leukemia, signs and symptoms of disease will appear.

The increased counts are not only caused by bacterial infections; infections with protozoa and worms can produce leukocytosis, sometimes over a relatively long time. Leukocytosis can also result from cancer, injury, physical or emotional stress or certain drugs.

Bone marrow disorders, including the various leukemias, are a much less common but more serious cause of leukocytosis. However, people with these disorders have extremely elevated white counts and other symptoms as well.

You didn't mention any chronic disease states like long-term infection or cancer to explain your years of high white counts. Your doctor has probably checked out any other causative factors as well.

So it sounds like your doctor and you are correct. You are probably just abnormally normal. Of course, if you continue to be concerned, a second opinion or a visit with a hematologist (blood specialist) should be considered.

Update on penicillin allergy: One of the most common allergies people list in their medical records is the allergy to penicillin. But a recent study indicates that many of these people are able to use penicillin without problems.

By doing a skin test for penicillin allergy, the researchers found that most people thought to have an allergy had a negative skin test. And these people, when given penicillin for an infection, did not react negatively.

This is important news because of the growing concern about use and resistance to "stronger" antibiotics, which can often be avoided by using penicillin first.

Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill., 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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