Can you interpret the lab results showing total protein 6.2 g/dL, globulin 1.9 g/dL, alanine aminotransferase 31 U/L, white blood cell count 11.9 ×10⁹/L with absolute neutrophils 9,092 cells/µL, and platelet count 454 ×10⁹/L?

Laboratory Interpretation

These laboratory values show mild leukocytosis with neutrophilia and thrombocytosis, suggesting an inflammatory or infectious process, while the protein and liver enzyme values remain within normal limits.

Complete Blood Count Analysis

White Blood Cell Count (11.9 ×10⁹/L)

• This represents mild leukocytosis, as the normal range is typically 4.0-11.0 ×10⁹/L 1
• The elevation is driven primarily by neutrophilia rather than other cell lines 2

Absolute Neutrophil Count (9,092 cells/µL)

• This is elevated neutrophilia, indicating a likely inflammatory or infectious process 3
• Neutrophilia is caused by increased marrow proliferation, redistribution among body neutrophil pools, stress, or corticosteroid effects 2
• The absolute neutrophil count is more sensitive than band count in predicting bacterial infections in most age groups 3
• This pattern suggests acute inflammation or bacterial infection rather than viral illness, as viral infections typically cause leukopenia (WBC <4.0 ×10⁹/L in 8-27% of influenza cases) 4, 5

Platelet Count (454 ×10⁹/L)

• This represents thrombocytosis, as normal platelet range is approximately 150-400 ×10⁹/L 1
• Reactive thrombocytosis commonly accompanies inflammatory conditions, infections, tissue damage, or malignancy 2
• This is distinct from the thrombocytopenia seen in parasitic infections like malaria, where platelet counts are typically low 6

Protein and Liver Function Analysis

Total Protein (6.2 g/dL or 62 g/L)

• This is at the lower end of normal or mildly decreased, as normal total protein is typically 64-83 g/L 7
• High total protein is common with untreated chronic infections due to increased immunoglobulin fraction secondary to B-cell hyperplasia 7
• Low total protein may indicate nutritional deficiency, nephrotic syndrome, or liver dysfunction 7
• In malignancy, total protein is often decreased (mean 66.0 g/L in cancer patients vs. 76.4 g/L in controls) 8

Globulin (1.9 g/dL or 19 g/L)

• This is low, as normal globulin is typically 23-35 g/L (calculated as total protein minus albumin) 9
• Assuming albumin is approximately 4.3 g/dL (43 g/L), the albumin-to-globulin ratio would be approximately 2.3, which is elevated 8
• In cancer patients, the albumin-to-globulin ratio is typically decreased (0.92 vs. 1.21 in healthy controls) due to increased globulins 8
• Low globulin with normal-to-low total protein suggests this is not a chronic inflammatory or malignant process, which would typically show elevated globulins 8, 9

Alanine Aminotransferase (ALT 31 U/L)

• This is within normal limits, as upper reference ranges vary from 31-79 U/L depending on gender and laboratory 7
• Normal ALT excludes significant hepatocellular injury 7
• In COVID-19 pneumonia, the average ALT was 37.6 U/L, and elevated transaminases were seen in 82% of severe cases 7

Clinical Interpretation and Differential Diagnosis

Most Likely Explanation

• The combination of leukocytosis with neutrophilia and thrombocytosis most strongly suggests an acute inflammatory or infectious process 2, 3
• The normal liver enzymes and relatively normal protein values argue against severe systemic illness 7

What This Pattern Rules Out

• Not consistent with viral infection: Viral infections typically cause leukopenia, not leukocytosis 4, 5
• Not consistent with parasitic infection: Tissue-invasive parasites cause eosinophilia, while blood-borne parasites like malaria cause thrombocytopenia, not thrombocytosis 6
• Not consistent with advanced malignancy: Cancer patients typically show decreased albumin-to-globulin ratio with elevated globulins, opposite of this pattern 8
• Not consistent with severe liver disease: ALT remains normal 7

What Requires Further Evaluation

• Clinical context is essential: Assess for fever, localized infection, recent surgery, trauma, or inflammatory conditions 3
• Consider bacterial infection: The neutrophilia pattern is most sensitive for bacterial processes 3
• Evaluate for inflammatory conditions: Reactive thrombocytosis accompanies many inflammatory states 2
• Repeat testing if persistent: Stable abnormalities warrant investigation, while transient changes may reflect acute stress response 1

Common Pitfalls to Avoid

• Do not dismiss mild abnormalities as insignificant without clinical correlation—the pattern of multiple mild abnormalities together provides more information than any single value 1
• Do not assume leukocytosis always indicates infection—stress, corticosteroids, and inflammatory conditions also cause neutrophilia 2
• Do not overlook the low globulin—while less commonly discussed, this finding helps narrow the differential diagnosis away from chronic inflammatory or malignant processes 8, 9
• Do not rely solely on laboratory values—integration with clinical presentation, symptoms, and physical examination findings is essential for accurate diagnosis 1, 3