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Suggest treatment for high TLC count

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Nephrologist
Practicing since : 1996
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Hi, My mother has high TLC count of 18700 seems to be increasing(initially 16400). Her age is 64. We got her few blood test, urine routine, urine culture, ultrasound of lower abdomen, heart echo, blood urea:35, creatinine: 0.95. All reports are normal. Her blood sugar level is also normal. As of now, we have given her blood sample for blood culture. She has no feeling of fever or any illness and working in her day-to-day activities normally. In November month, she was admitted to hospital and was given intravenous medicines to control TLC. But its seems to be increasing again.
Posted Fri, 31 Jan 2014 in Kidney Conditions
 
 
Answered by Dr. Ravi Bansal 1 hour later
Brief Answer: High TLC Detailed Answer: Hi XXXXXXX High TLC can Occur in 1. infections- Bacterial or fungal- can be in chest, urine, abdomen or blood stream. 2. use of steroids. 3. leukemoid reaction where TLC is high without infection. Generally patient of infection should have fever. Chest Xray and urine routine Pus cells and ultrasound generally pick up the site of infection. In case all tests are normal but patient has progressively rising TLC like increase from 10000 to 20000 over 3 to 4 days then it should be taken as evidence for infection and treated empirically while further search of site of infection must be made. these could include tests like CT chest and CT abdomen, Bone marrow, Bone scans,etc. Sometimes TLC increase can occur without infection , then a close watch over the levels is enough if patient has no symptoms. In any case you should follow advice of your treating physician and let him take the decision. Best wishes, if any further query please discuss.
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Follow-up: Suggest treatment for high TLC count 29 minutes later
Hello Dr XXXXXXX Thanks for your response. My mother TLC has increased by 2000 (approx) from 16400 to 18700 in almost 1 week and may be the number has kept increasing since time of discharge at November'13 end. I can submit her blood culture report due to be received by 9th Jan'14 or upload any relevant reports that you would need to review. During her hospitalization, Doctors did not do CT scan or bone marrow test as TLC came to normal with medication. If the blood culture reports come normal, do you recommend CT scan or bone marrow test or which? The only worry is that we still dont know the cause of increased TLC :(
 
 
Answered by Dr. Ravi Bansal 2 hours later
Brief Answer: high tlc Detailed Answer: I think if patient is totally normal and there is no sign of any infection you can first do the tlc daily for 2 days and see in it is rising further. Also simultaneously send for blood and urine culture. But if patient has any physical problem then you can start antibiotics under guidance of your treating doctor. Further investigation plan to be guided on the outcome of these measures. Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for high TLC count 30 hours later
Hello Dr XXXXXXX We have gone for blood culture and the report says "sterile after 48 hrs of aerobic incubation... at 37 degrees centigrade" Though urine routine and urine culture is normal. Should we go further test that you would suggest or retest TLC to check count if there is further increase or please advise as my mother fears going back to be admitted in hospital?
 
 
Answered by Dr. Ravi Bansal 14 minutes later
Brief Answer: high tlc Detailed Answer: Please repeat the TLC and Dlc . Do it everyday for 3 days and see if rising.
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Follow-up: Suggest treatment for high TLC count 36 hours later
Hello Dr. XXXXXXX We have gone for TLC DLC yesterday and it again slightly increased (from 18700 (Monday) to 19200 (Thursday) in 4 days). As of now, we have given blood sample for peripheral blood smear test and I would share the report result with you. Regards
 
 
Answered by Dr. Ravi Bansal 1 hour later
Brief Answer: high TLC. Detailed Answer: XXXXXXX TLC is high but there is no increases in polymorphs. If your patient does not any fever or any other symptoms and on clinical examination she is OK you can follow the TLC for further 2 days to see if still rising. meanwhile all efforts should be made to find out the cause under guidance of your treating doctor. In any case if TLC is rising further it is better she is hospitalized and and investigated in hospital setting. further opinion is only possible after clinically examining her. Best wishes
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Follow-up: Suggest treatment for high TLC count 32 hours later
Hello Dr. XXXXXXX We have gone for 3 days of consecutive TLC 09th Jan'14, Thursday - TLC 19200 10th Jan'14, Friday - TLC 18200 11th Jan'14, Saturday - TLC - 19000 I'm attaching report (reportpdf) for your reference which includes another two tests (Procalcitonin and Urin Routine). As of now, there is no fever or any symptom.
 
 
Answered by Dr. Ravi Bansal 16 hours later
Brief Answer: high tlc Detailed Answer: The counts are static around the same level. the DLC shows normal polymorhs. Procalcitonin and urine reports are normal. there is no evidence for infection as such. eosinophils are more that can be in allergic conditions. You should discusds with a hematologist about your case to find out any other cause for eosinophils and high TLC. Likelihood of infection is less. Best wishes
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Follow-up: Suggest treatment for high TLC count 20 hours later
Thanks Dr XXXXXXX I would discuss with Haematologist. For how long should we monitor TLC or should we re-test every month to ensure that its not rising? Are there any allergy tests available through which we know its cause for rise? Hello Dr XXXXXXX For how long should we monitor TLC or should we re-test every month to ensure that its not rising? Are there any allergy tests available through which we know its cause for rise? Regards, XXXX
 
 
Answered by Dr. Ravi Bansal 48 hours later
Brief Answer: high tlc. Detailed Answer: hi XXXXXXX sorry coundn't answer earlier, was travelling. You can monitor TLC DLC every week. and follow hematologist advice. there are no tests to test for allergy. Thanks.
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