From the Research
The patient's blood work indicates a persistent elevation in white blood cell count, primarily due to high neutrophil counts, suggesting an ongoing inflammatory or infectious process that warrants further investigation. The white blood cell count (WBC) has been consistently elevated over the past 9 months, with the most recent value at 13.3 K/mcL, well above the normal range of 4.6-10.2 K/mcL, as noted in the study on leukocytosis 1. This elevation is primarily due to high neutrophil counts (absolute neutrophils 10.96 K/mcL, with normal being 1.80-7.70 K/mcL). Additionally, there's a relative lymphopenia (low lymphocyte percentage at 10.3%, below the normal 17.9-49.6%). The red blood cell indices show some mild abnormalities, including a slightly high MCV (mean corpuscular volume) at 97.3 FL.
These findings suggest an ongoing inflammatory or infectious process, which is supported by the study on elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis 2. The persistent neutrophilia (elevated neutrophils) over several months warrants further investigation to rule out chronic infection, inflammatory disorders, or potentially a myeloproliferative disorder.
The patient should follow up with their healthcare provider for additional testing, which might include:
- Inflammatory markers (ESR, CRP) to assess the level of inflammation
- Blood cultures if infection is suspected
- Possibly bone marrow evaluation if a hematologic disorder is considered The chronicity of these abnormalities (present for at least 9 months) makes this more concerning than a transient elevation due to acute illness, as noted in the study on assessment of patient laboratory data in the acutely ill 3.
It is also important to consider the potential links between elevated leukocyte counts and increased mortality, as discussed in the study on elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis 2. However, the most recent and highest quality study on this topic is the one published in 2022, which found that ceftriaxone could provide an alternative for the treatment of MSSA BSIs in acute care and OPAT settings 4.
Therefore, the patient should be closely monitored and further evaluated to determine the underlying cause of the elevated WBC count and to guide appropriate treatment, with consideration of the potential benefits and risks of different treatment options, including ceftriaxone.