What's the Take Home?

A 38-Year-Old Woman With Leukocytosis

Volume 60 - Issue 5 - May 2020

  • AUTHOR:
    Ronald N. Rubin, MD1,2—Series Editor

    AFFILIATIONS:
    1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
    2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania

    CITATION:
    Rubin RN. A 71-year-old man with pain and stiffness in the hand. Consultant. 2020;60(5):e5. doi:10.25270/con.2020.05.00005

    DISCLOSURES:
    The author reports no relevant financial relationships.

    CORRESPONDENCE:
    Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

    A 38-year-old woman was referred for evaluation of an elevated white blood cell (WBC) count that had been found incidentally on a routine yearly evaluation. She brought her complete blood cell count (CBC) results with her, which had been obtained by her new primary care provider (PCP) 1 month previously (earlier in the year, she had changed PCPs). The CBC revealed a normal hemoglobin level (14.28 g/dL), normal red blood cell indices, and a normal platelet count. However, the total WBC count was 13,400/µL, with essentially all of the elevation accounted for by an increased number of neutrophils, specifically 10,900/µL. Both the Coulter Counter and the automatic “referral” to a commercial pathologist reported rare band forms but no other abnormal WBC forms on examination of the peripheral blood smear. Results of an accompanying basic and comprehensive metabolic and biochemical blood profile were entirely normal.

    The patient is a healthy woman whose only major medical diagnosis is asthma, which had been much more severe in childhood but was less so now, except when she experiences a significant upper respiratory tract infection (URI). Her long-term medications include oral contraceptives and acetaminophen and/or ibuprofen as needed for minor orthopedic symptoms that are occasionally associated with her exercise programs.

    Physical examination revealed totally normal vital signs. Examination of the head, eyes, ears, nose, and throat revealed normal findings, and there was no thyromegaly. Her chest was essentially clear, save for a rare expiratory wheeze. Abdominal examination findings were normal, with no hepatosplenomegaly. The extremities were negative for rashes, lesions, or edema.