From the Guidelines
An elevated white blood cell count in the context of gastrointestinal bleeding should not automatically be attributed to infection, but rather considered a reactive leukocytosis due to the stress of bleeding, as evidenced by studies on the management of variceal hemorrhage 1. This elevation typically ranges from 10,000 to 20,000 cells/μL and represents a normal physiologic stress response to bleeding. The increase occurs primarily due to demargination of neutrophils from blood vessel walls in response to catecholamine release during the stress of blood loss. When evaluating a patient with GI bleeding, it's crucial to consider the entire clinical picture, including:
- Vital signs
- Physical examination findings
- Other laboratory values
- The presence of other signs like fever, which could indicate infection Serial white blood cell counts can be helpful to monitor trends, with a persistent or worsening elevation potentially suggesting complications such as infection, perforation, or ongoing bleeding. Given the high risk of bacterial infections in cirrhotic patients with upper GI bleeding 1, short-term prophylactic antibiotics should be considered standard practice, with the recommended antibiotic schedule being norfloxacin administered orally at a dose of 400 mg BID for 7 days 1.
From the Research
Elevated White Count in GI Bleed
- Elevated white count, also known as leukocytosis, is a common finding in patients with upper gastrointestinal bleeding, occurring in approximately 63% of cases 2.
- The presence of leukocytosis on admission is associated with more severe bleeding episodes, as evidenced by higher rates of tachycardia, hypotension, and increased blood transfusion requirements 2.
- Patients with leukocytosis tend to have a longer hospital stay and require more frequent surgical intervention for bleeding compared to those with a normal white count 2.
- However, leukocytosis does not appear to be a significant predictor of mortality in patients with upper gastrointestinal bleeding 2.
- The management of upper gastrointestinal bleeding involves a comprehensive approach, including risk stratification, diagnostic modalities, localization of bleeding, transfusion strategies, and adjunct therapies 3, 4, 5, 6.