What is the clinical significance of a patient's laboratory results showing leukocytosis (White Blood Cell count 10.1 K/uL), erythrocytosis (Red Blood Cell count 5.73 M/uL), hyperhemoglobinemia (hemoglobin 17.0 g/dL), neutrophilia (#neut 7.1 K/uL), monocytosis (#mono 0.8 K/uL), and lymphopenia (%lymph 20%)?

From the Guidelines

This patient's blood test results indicate a possible inflammatory or infectious process, and further evaluation is warranted to determine the underlying cause. The elevated red blood cell count (5.73 M/uL) and hemoglobin (17.0 g/dL) suggest erythrocytosis, which could be due to dehydration, smoking, living at high altitude, or a chronic lung condition 1. The neutrophil count is elevated (7.1 K/uL), along with monocytes (0.8 K/uL), suggesting an active inflammatory or infectious process, as supported by the study that found leukocytosis with a leukocyte count of 14,000 cells/mm3 had a likelihood ratio of 3.7 for detecting bacterial infection 1. Key findings include:

• Elevated neutrophil count (7.1 K/uL)
• Elevated monocyte count (0.8 K/uL)
• Low lymphocyte percentage (20%)
• Normal overall white blood cell count (10.1 K/uL) but with a differential shift toward neutrophils These findings together suggest the body is responding to some form of inflammation or infection. Hydration status should be assessed, and if symptoms like fever, fatigue, or localized pain are present, further evaluation would be warranted, including diagnostic laboratory studies as recommended by the clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities 1. If this is a new finding, follow-up testing in 2-4 weeks might be appropriate to see if these values normalize after resolution of any acute process.

From the Research

White Blood Cell Count

• The white blood cell count is 10.1 K/uL, which is within the normal range of 4.5 - 11.5 K/uL 2, 3, 4.
• However, the neutrophil count is 7.1 K/uL, which is higher than the normal range of 1.4 - 6.5 K/uL, indicating a potential infection or inflammatory process 2, 3, 5.
• The monocyte count is 0.8 K/uL, which is higher than the normal range of 0.0 - 0.7 K/uL, suggesting a possible infection or inflammatory condition 2, 3, 5.

Red Blood Cell Count

• The red blood cell count is 5.73 M/uL, which is higher than the normal range of 4.50 - 5.30 M/uL, indicating a potential condition such as polycythemia 4.
• The hemoglobin level is 17.0 g/dL, which is higher than the normal range of 13.0 - 16.0 g/dL, suggesting a possible condition such as polycythemia 4.
• The hematocrit is 53.1%, which is within the normal range of 40.0 - 57.0% 4.

Platelet Count

• The platelet count is 223 K/uL, which is within the normal range of 150 - 450 K/uL 4.

Other Parameters

• The mean corpuscular volume (MCV) is 93 fL, which is within the normal range of 80 - 99 fL 4.
• The mean corpuscular hemoglobin (MCH) is 29.7 pg, which is within the normal range of 27.0 - 31.0 pg 4.
• The mean corpuscular hemoglobin concentration (MCHC) is 32 g/dL, which is within the normal range of 32 - 36 g/dL 4.
• The red cell distribution width (RDW) is 14.6%, which is within the normal range of 11.5 - 15.5% 4.
• The mean platelet volume (MPV) is 9.7 fL, which is within the normal range of 7.4 - 10.4 fL 4.

Potential Causes

• The elevated neutrophil and monocyte counts may indicate a potential infection or inflammatory process 2, 3, 5.
• The elevated red blood cell count and hemoglobin level may suggest a condition such as polycythemia 4.
• The patient's symptoms and medical history should be evaluated to determine the underlying cause of these laboratory findings 2, 3, 5, 6, 4.