From the Guidelines
A white blood cell (WBC) count of 70,000 per microliter (70 K) is significantly elevated and requires immediate medical attention, although it does not meet the traditional definition of hyperleukocytosis, which is typically defined as a WBC count over 100,000 per microliter 1. This condition, known as leukocytosis, can indicate serious underlying issues such as infection, inflammation, leukemia, or other blood disorders. You should seek emergency medical care right away as this is not a condition to manage at home. At the hospital, doctors will likely perform additional tests including a complete blood count with differential, blood cultures, and possibly a bone marrow biopsy to determine the cause. Treatment will depend on the underlying cause - antibiotics for severe infections, steroids for inflammatory conditions, or chemotherapy if leukemia is diagnosed. While waiting for medical care, monitor for fever, unusual bleeding, bruising, fatigue, or shortness of breath, as these could indicate worsening of your condition. This extreme elevation in white blood cells can potentially lead to blood thickening and impaired circulation, which is why prompt medical evaluation is essential. Do not delay seeking care as this level of elevation requires professional assessment and management. In cases of hyperleukocytosis, hydroxyurea is recommended to lower WBC counts, given at dosages up to 50 to 60 mg/kg per day, until WBCs are less than 10-20 x 10^9/L 1. Special attention should be given to the prevention of tumor lysis syndrome, which can be achieved through hydration, control of uric acid production using allopurinol or rasburicase, and control of urine pH 1. Given the potential risks associated with high WBC counts, it is crucial to prioritize immediate medical attention to prevent complications and improve outcomes. Key considerations in management include:
- Prompt medical evaluation
- Determination of the underlying cause
- Appropriate treatment based on the cause
- Monitoring for signs of worsening condition
- Prevention of tumor lysis syndrome
- Use of hydroxyurea to lower WBC counts if necessary, as per the guidelines 1.
From the Research
High WBC Count
A high white blood cell (WBC) count of 70 k can have various potential etiologies, including malignant and nonmalignant causes 2.
Possible Causes
Some possible causes of a high WBC count include:
- Infection, particularly bacterial 2
- Certain medications 2
- Asplenia 2
- Smoking 2
- Obesity 2
- Chronic inflammatory conditions 2
- Hematologic malignancy 2
Diagnostic Approach
To diagnose the cause of a high WBC count, a repeat complete blood count with peripheral smear may be performed to provide helpful information, such as:
- Types and maturity of white blood cells 2
- Uniformity of white blood cells 2
- Toxic granulations 2
- Leukocyte differential to show eosinophilia in parasitic or allergic conditions, or lymphocytosis in childhood viral illnesses 2
Reference Values
Reference values for the differential count of white blood cells in peripheral blood smear have been established, which can be helpful in diagnosing and monitoring diseases 3.
Automated Differential Count
Automated systems, such as dual-stage convolutional neural networks, have been proposed to conduct white blood cell differential counts from bone marrow smear images, which can improve the accuracy and efficiency of the process 4.
Clinical Significance
A high WBC count can be a sign of underlying infection or other conditions, and prompt identification of the cause is crucial for appropriate treatment and management 2, 5, 6.