White blood cell count

Hematology. The functional status of blood and of the blood-forming tissues can be assessed by tests which include red and white blood cell counts, platelet counts, clotting time, coagulation tests, and examination of bone marrow. Such tests, in addition to detecting abnormahties, may also allow differentiation between primary and secondary effects on blood and blood-forming tissues (75). 

Haematological characteristics (haemoglobin level, red blood and white blood cell counts, platelet count, blood clotting time). 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

More than half of the patients receiving this drug by the parenteral route experience some adverse reaction. Severe and sometimes life-threatening reactions include leukopenia (low white blood cell count), hypoglycemia (low blood sugar), thrombocytopenia (low platelet count), and hypotension (low blood pressure). Moderate or less severe reactions include changes in some laboratory tests, such as the serum creatinine and liver function tests. Other adverse reactions include anxiety, headache, hypotension, chills, nausea, and anorexia Aerosol administration may result in fatigue a metallic taste in the mouth, shortness of breath, and anorexia... 

MTX is a potentially toxic dmg that is also used in the treatment of malignancies and psoriasis. Nausea, vomiting, a decreased platelet count, leukopenia (decreased white blood cell count), stomatitis (inflammation of the oral cavity), rash, pruritus, dermatitis, diarrhea, alopecia (loss of hair), and diarrhea may be seen with the administration of this dmg. 

Hematological Effects. Normal hemoglobin, hematocrit, white blood cell count, and differential... 

Normal except for an eosinophil count of 7% of the total white blood cell count... 

White blood cell count with an associated increase in polymorphonuclear (PMN) leukocytes and bands may occur in acute pulmonary infection however, infection may occur without these laboratory abnormalities. 

Signs and symptoms of SBP in a patient with cirrhosis and ascites should prompt a diagnostic paracentesis (Fig. 19-4). In SBP, there is decreased total serum protein, elevated white blood cell count (with left shift), and the ascitic fluid contains at least 0.250 x 103/mm3 (0.250 x 109/L) neutrophils. Bacterial culture of ascitic fluid may be positive, but lack of growth does not exclude the diagnosis. 

Other possible laboratory abnormalities include elevated white blood cell count, hyperglycemia, hypocalcemia, hyperbilirubinemia, elevated serum lactate dehydrogenase (LDH), and hypertriglyceridemia. 

The goals of treatment for acute pancreatitis include (1) resolution of nausea, vomiting, abdominal pain, and fever (2) ability to tolerate oral intake (3) normalization of serum amylase, lipase, and white blood cell count and (4) resolution of abscess, pseudocyst, or fluid collection as measured by CT scan. 

TABLE 34-11. Monitoring of White Blood Cell Count and Absolute Neutrophil Count during Clozapine Treatment... 

Perform urinalysis, urine toxicology, thyroid function, and white blood cell count in the elderly to rule out urinary tract infection... 

One month later, GD is back for a follow-up visit. She notes that her thyrotoxic symptoms are gone, and overall, she feels great. She is receiving propylthiouracil 100 mg three times daily. Her most recentTSH was 0.9 milliunit/L (normal 0.5-2.5 milliunits/L), and her free T4 was 1.6 ng/dL (20.6 pmol/L normal 0.7-1.9 ng/dL, or 9.0-24.5 pmol/L). However, over the past few days she has developed a sore throat and feels achy. She wonders if she has the flu. Her vital signs show a pulse of 92 beats/minute and a temperature of 38.3°C (101 °F). A complete blood count reveals a total white blood cell count of 1 00/mm3 or 0.1 x 1 09/L (normal 4000-10,000/mm3 or 4-10 x 1 09/L) with 15 neutrophils (absolute neutrophil count 150). 

What will you tell GD regarding the possible cause of her new symptoms, the significance of her low white blood cell count, and recommended actions ... 

Monitor for symptoms of neutropenia (e.g., fever or sore throat), and check white blood cell count if symptoms occur. 

Complete blood count Slight elevation in white blood cell count with a normal differential slight anemia, thrombocytosis... 

A standard initial laboratory evaluation for anemia includes a complete blood count (evaluation of the serum hemoglobin and hematocrit concentration, white blood cell count, platelets), measurement of the red blood cell count and size, and review of peripheral smear. 

White blood cell count with differential... 

TABLE 66-1. White Blood Cell Count and Differential... 

Every patient receiving antimicrobial therapy for skin and soft tissue infections must be monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white blood cell count, erythema, edema, and pain that begin within 48 to 72 hours. To ensure safety, dose antibiotics according to renal and hepatic function as appropriate, and monitor for and minimize adverse drug reactions, allergic reactions, and drug interactions. 

White blood cell count 17.3 x 103/pL, serum creatinine 0.8 mg/dL (70.7 pmol/L)... 

A 70-year-old man presents to the emergency department because of diffuse abdominal pain and nonbloody diarrhea. One day earlier he had been discharged from the hospital, where he had received ceftriaxone and levofloxacin for 7 days for an upper respiratory infection. Soon after going home, he passed numerous liquid brown stools. A few hours later, the patient became disoriented, and an ambulance was called. His medical history is unremarkable. Laboratory values White blood cell count 50,000 cells/mm3, hematocrit 43%, sodium 125 mmol/L, potassium 5.6 mmol/L, C02 14 mmol/L, and metabolic acidosis. An abdominal radiograph series show no evidence of obstruction. The patient was admitted to the hospital. 

In the hospital, he receives fluids and metronidazole 500 mg every 8 hours intravenously. Stool was sent for C. difficile toxin assay, which came back positive. The patient continues to have abdominal pain but no bowel movement. On day 3 of hospitalization, his abdomen is distended with diffuse pain. His white blood cell count remains elevated. A CT scan of the abdomen showed colonic dilatation to greater than 6 cm. The patient became febrile and hypotensive, requiring multiple pharmacologic support for hypotension. 

CBC, complete blood cell count CNS, central nervous system IM, intramuscular WBC, white blood cell count. 

Patients with normalized white blood cell count... 

A 43-year-old male in the surgical ICU after exploratory laparotomy following a motor vehicle accident develops fever that is unresponsive to broad-spectrum antibacterial therapy (piperacillin-tazobactam 3.75 g every 6 hours, gentamicin 120 mg every 8 hours, and vancomycin 1 g every 12 hours). The patient has a central venous catheter and a Foley catheter. Blood cultures are negative at the time, but the patient has yeast growing in the sputum and urine. Laboratory studies reveal a white blood cell count of 11,300 cells/mm3 (11.3 x 109/L). 

The patient is started on fluconazole 400 mg/day, but 3 days later has persistent fever and develops hypotension and decreased urine output. Blood cultures reveal a germ tube-negative yeast growing in the blood. Laboratory studies revealed a white blood cell count of 12,300/mm3 (12x109/L), aspartate aminotransferase 68 IU/L (1.13 pKat/L), alanine aminotransferase 75 IU/L (1.25 pKat/L), alkaline phosphatase 168 IU/L (2.8 pKat/L), and normal bilirubin. Serum creatinine is 1.8 mg/dL (159 pmol/L). 

White blood cell count 5000 cells/mm3, serum creatinine 80 pmol/L (0.9 mg/dL), glucose 5.3 mmol/L (1 00 mg/dL)... 

Laboratory monitoring is performed before initiating therapy and before each cycle of chemotherapy. A complete blood count should be obtained prior to each course of chemotherapy to ensure that hematologic values are adequate. In particular, white blood cell counts and absolute neutrophil counts can be decreased in patients receiving chemotherapy such as irinote-can and 5-FU and increase the risk of infection. Baseline liver function tests and an assessment of renal function should be done prior to and periodically during therapy. Other selected laboratory tests include checking for the presence of protein in the urine in patients receiving oxaliplatin and bevacizumab. 

White blood cell count greater than or equal to 15,000 mm3 (15x109/L)... 

Lymphocytopenia [count less than 600 mm3 (0.6 x 109/L) or less than 8% (0.08) of white blood cell count or both] International Prognostic Index—Diffuse, Aggressive Non-Hodgkin s Lymphoma... 

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