From the Guidelines
Chronic elevated white blood cell count (leukocytosis) is a condition that requires immediate medical evaluation to determine its underlying cause, which can range from chronic infections, inflammatory conditions, certain medications, smoking, stress, hematologic disorders, to rare blood cancers like leukemia or myeloproliferative disorders. The most recent and highest quality study, 1, highlights the importance of identifying the cause of leukocytosis, as high WBC counts can lead to leukostasis, resulting in tissue damage and organ compromise.
Common Causes of Leukocytosis
- Chronic infections
- Inflammatory conditions
- Certain medications (like corticosteroids)
- Smoking
- Stress
- Hematologic disorders
- Rare blood cancers like leukemia or myeloproliferative disorders
Diagnostic Approach
A healthcare provider will likely order additional tests, including:
- Complete blood count with differential
- Peripheral blood smear
- Possibly bone marrow examination, depending on the severity and clinical context
Management
No specific medication is universally recommended, as treatment depends entirely on the underlying cause. For example:
- If an infection is identified, appropriate antibiotics would be prescribed
- If an inflammatory condition is present, anti-inflammatory medications might be indicated
- Lifestyle modifications like smoking cessation may help in some cases
Importance of Follow-up
Regular follow-up monitoring of blood counts will likely be necessary to track changes over time and assess response to any interventions, as noted in 1, which discusses the clinical and haematological criteria for the definition of accelerated phase and blast phase in chronic myeloid leukemia.
Rare but Serious Causes
In some cases, leukocytosis can be a sign of a more serious underlying condition, such as leukemia, as discussed in 1. It is essential to work with a healthcare provider to determine the cause of leukocytosis and develop an appropriate treatment plan. Other studies, such as 1, may provide additional information on the side effects of certain medications, but the most recent and highest quality study, 1, should be prioritized when making a definitive recommendation.
From the Research
Causes of Chronic Elevated White Blood Cell (WBC) Count
- Inflammation is a key factor associated with elevated WBC count, and it can be caused by various conditions such as infection, trauma, and certain diseases 2
- Systemic inflammation, disease progression, and poor prognosis are linked to elevated leukocyte count, which can be a harbinger of increased risk of cancer, cardiovascular disease, type 2 diabetes, and other age-related conditions 2
- Hematologic malignancies can cause elevated WBC count, and inflammatory markers such as NLR, PLR, PMR, HLR, SII, and dNLR can be used as predictive factors for these conditions 3
- Ischemic stroke patients with elevated WBC counts are at increased risk of new vascular events and mortality, suggesting that elevated WBC count can be a marker of underlying conditions that need special attention 4
- Elevated WBC count can also be associated with Clostridium difficile infection (CDI), although an isolated WBC elevation has low sensitivity and specificity as a predictor of fecal C. difficile NAAT positivity in the inpatient setting 5
Underlying Conditions
- Certain diseases, such as hematologic malignancies, can cause chronic elevated WBC count 3
- Infection, trauma, and inflammation can also lead to elevated WBC count 2
- Systemic inflammation and subclinical disease can be indicated by elevated leukocyte count, even within the normal range 2
- Age-related conditions, such as cancer, cardiovascular disease, and type 2 diabetes, can be associated with elevated WBC count 2
Diagnostic Markers
- Inflammatory markers, such as NLR, PLR, PMR, HLR, SII, and dNLR, can be used to predict hematologic malignancies and other conditions associated with elevated WBC count 3
- Leukocyte count can be a reliable morphological indicator of chronic systemic inflammation, disease progression, and poor prognosis, especially among older adults 2
- C-reactive protein and interleukin 6 can also be used as markers of systemic inflammation, and they correlate positively with leukocyte count 2