From the Research
A white blood cell count of 38.8 is significantly elevated and requires immediate medical attention, even in someone recovering from pneumonia, as it may indicate a severe infection, worsening pneumonia, or development of complications like lung abscess or empyema, with a mortality rate of 2.8% for WBC counts in this range, as reported in the study by 1. The patient should be evaluated promptly by a healthcare provider to identify the cause of this extreme leukocytosis. Key steps in evaluation include:
- Obtaining blood cultures to identify any bacterial infections
- Chest imaging (X-ray or CT scan) to assess for complications like lung abscess or empyema
- Possibly additional laboratory tests to rule out other causes of leukocytosis, such as leukemia Treatment will depend on the specific findings but may include broad-spectrum antibiotics, such as a combination of ceftriaxone 1-2g IV daily plus azithromycin 500mg daily, or piperacillin-tazobactam 4.5g IV every 6-8 hours, until culture results are available, as discussed in the study by 2. Hospitalization is likely necessary for close monitoring and intravenous antibiotics. Other causes of marked leukocytosis, such as leukemia, should also be considered, especially if the patient has other concerning symptoms like easy bruising or unexplained weight loss, as highlighted in the study by 3. The most common infections associated with extreme leukocytosis are pneumonia, UTI or pyelonephritis, and abscesses, as reported in the study by 1. Given the potential for severe outcomes, it is crucial to prioritize the patient's morbidity, mortality, and quality of life, and to manage the patient with the highest level of care, as emphasized in the study by 4.