What are the implications of a patient with leukocytosis (White Blood Cell count of 118), taking 8 tablets of aspirin (acetylsalicylic acid) 325mg daily for over a year, with a negative watergate (likely referring to a water test or possibly a reference to a specific medical test, but assuming it refers to a negative result on a test for anemia or other condition) and anemia (implied by the mention of RBC, Red Blood Cells)?

From the Guidelines

I strongly recommend that you immediately stop taking the high dose of aspirin (8 tablets of 325mg daily) and seek emergency medical attention due to the risk of aspirin toxicity and the concerning lab results, including an extremely elevated white blood cell count (WBC) of 118. Your WBC count is significantly higher than the normal range, suggesting a serious infection or inflammation, and the presence of large WBCs could indicate a significant immune response. The long-term use of high-dose aspirin puts you at a high risk for gastrointestinal bleeding, kidney damage, and other complications, as noted in studies such as 1. The optimal dose of aspirin for preventing cardiovascular disease events is not known, but a dose of 75 mg per day seems as effective as higher doses, and the risk for gastrointestinal bleeding may increase with the dosage, as discussed in 1 and 1. Given your lab results and high-dose aspirin use, it is crucial to seek medical attention to address potential aspirin toxicity and the underlying cause of your elevated WBC count. A healthcare provider will likely perform additional tests and may recommend alternative pain management strategies if that was the purpose of your aspirin use. Key points to consider include:

• The risk of gastrointestinal bleeding associated with aspirin use, especially at high doses, as highlighted in 1 and 1.
• The importance of assessing cardiovascular and bleeding risk factors, as mentioned in 1.
• The need for immediate medical attention to address potential aspirin toxicity and the underlying cause of your elevated WBC count.

From the FDA Drug Label

Warnings ... Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The chance is higher if you are age 60 or olderHave had stomach ulcers or bleeding problemsTake a blood thinning (Anticogulant) or steroid drugTake other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)have 3 or more alcoholic drinks every day using this product Directions drink a full glass of water with each dose adults and children 12 years and over: take 4 to 8 tablets every 4 hours not to exceed 48 tablets in 24 hours unless directed by a doctor

The patient is taking 8 tablets of aspirin 325 mg, which is within the recommended dose. However, the patient has been taking this dose for over a year.

• Long-term use of aspirin may increase the risk of stomach bleeding.
• The patient's WBC count is elevated (118 large WBC), which may indicate an underlying infection or inflammation.
• The patient's RBC results are not provided, but the elevated WBC count may be related to the long-term use of aspirin. Given the potential risks associated with long-term aspirin use, it is recommended to consult a doctor to evaluate the patient's condition and determine the best course of action 2.

From the Research

Aspirin Dosage and Effects

• The user is taking 8 tablets of aspirin 325 mg per day, which is a high dose of aspirin [(3,4)].
• Studies have shown that low-dose aspirin (75-325 mg daily) is commonly used for the secondary prevention of cardiovascular and cerebrovascular events 4.
• The appropriate dose of aspirin for primary and secondary prevention of stroke and myocardial infarction (MI) is uncertain, but 160 mg/day is consistently effective in lowering the risk of MI in men 3.
• The risk of major bleeding with 160 mg/day is the same as with 80 mg/day, and the risk of fatal bleeding is also the same with 80 and 160 mg/day 3.

Bleeding Risks and Interactions

• Aspirin can cause a systemic bleeding tendency by impairing thromboxane-dependent platelet aggregation, and the clinical risks of bleeding are enhanced by concomitant use of alcohol or anticoagulants 5.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can interfere with the antiplatelet effect of aspirin, and the interaction varies amongst agents and is highly dependent on numerous factors [(6,7)].
• The concomitant use of low-dose aspirin and NSAIDs is prevalent, particularly in the elderly, and the clinical decision making for concomitant NSAID and low-dose aspirin regimens remains at the patient level 6.

Laboratory Results and Medical History

• The user's laboratory results show a WBC count of 118 with large WBC, and a negative watergate test [no relevant study found].
• The user's medical history and current condition are not fully described, but the user is taking a high dose of aspirin, which may increase the risk of bleeding and other adverse effects [(3,5,4,6,7)].