From the Guidelines
Yes, white blood cell (WBC) count can be elevated in response to trauma. When the body experiences physical trauma, it triggers an inflammatory response that includes increasing the production and release of white blood cells, as part of the body's natural defense mechanism to protect against potential infection and facilitate healing 1. This elevation in WBC count, known as leukocytosis, is a normal physiological response to injury and helps with tissue repair and fighting potential pathogens that might enter through damaged tissues.
Key Points to Consider
- The bone marrow typically releases more neutrophils, a type of white blood cell, into circulation within hours after trauma occurs.
- The degree of WBC elevation often correlates with the severity of trauma, and levels typically return to normal as healing progresses.
- Persistently high or increasing WBC counts after trauma may indicate complications such as infection and should be monitored carefully, considering the potential for cytokines, endothelial injury, and thrombocytopaenia, as well as increased pro-inflammatory extravasation and myelopoiesis 1.
Clinical Implications
- It is essential to monitor WBC counts in trauma patients to differentiate between the normal inflammatory response and potential infections or other complications.
- Understanding the body's response to trauma, including the release of DAMP (Damage-Associated Molecular Patterns) from organ injury and muscle wasting, can help in managing patient care and preventing further complications 1.
From the Research
White Blood Cell Response to Trauma
- White blood cell count (WBC) can be raised in response to trauma, as it is a cardinal sign of inflammation, which is the physiologic reaction to cellular and tissue damage caused by trauma, ischemia, infection, and other pathologic conditions 2, 3.
- The dynamics of WBC changes in response to trauma are not well established, but studies have shown that WBC count can be elevated in trauma patients, and this elevation can be associated with the severity of injury 4, 5.
- Leukocytosis, or an elevated WBC count, can be caused by a variety of factors, including physical stress, emotional stress, and medications, in addition to trauma and infection 6.
Association with Injury Severity
- Studies have shown that WBC count can be associated with the severity of injury in trauma patients, with higher WBC counts corresponding to more severe injuries 4, 5.
- However, the relationship between WBC count and injury severity is not always straightforward, and other factors such as race and mechanism of injury can also influence WBC count 4.
- WBC count can be used as an adjunct for making disposition decisions in trauma patients, but it should not be relied upon as the sole indicator of injury severity 5.
Clinical Implications
- Elevated WBC counts in trauma patients can indicate a higher risk of adverse outcomes, including death from COVID-19, sepsis, and myocardial infarction 2, 3.
- A significant elevation in WBC count in a blunt trauma patient, even with minimal initial signs of severe injury, should heighten suspicion for occult injury 5.
- Primary bone marrow disorders should be suspected in patients with extremely elevated WBC counts or concurrent abnormalities in red blood cell or platelet counts 6.