Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I understand your concern and would explain that a careful differential diagnosis between different causes of leucocytosis (WBC increase) should be done:

-infection (it may be a pneumonia from different causes)
-inflammation (inflammatory bowel disease, rheumatoid arthritis, and vasculitis)
-medications induced (heparin, steroids, antiepilepsy drugs,
-stressful situations (eg, trauma, severe pain)
-Hypoxia: low blood oxygen saturation could lead to leukocytosis (this could be related to her copd)
- Sarcoidosis is another inflammatory disorder, which could cause lung lymph nodes coupled leukocytosis
-hematological disorders (leukemia and myeloproliferative disorders), but in these cases usually the number of WBC is much higher.

Could you upload her complete blood count with WBC formula results for me to review?

Her cardiac medical history doesn't seem to be related to her symptoms.

I recommend consulting with the GP for a careful physical examination, a resting ECG, a chest x ray study, respiratory function tests, and some blood lab tests:

- PCR, sedimentation tests (inflammation)
- blood gas analysis
- cortisol plasma levels (adrenal gland function)
- kidney and liver function tests
- angiotensin-converting enzyme (ACE) plasma levels
- alkaline phosphatase level
- uric acid plasma levels
- blood electrolytes, including calcium.

If all the above tests result normal, a hematological consult is necessary.

But before going into the bone biopsy, a careful direct examination on the microscope of the white blood cell is necessary.

The bone biopsy would be the last exam to do, in her situation, taking into consideration her age and her past medical history.

Hope to have been helpful!

Feel free to ask any other questions, whenever you need!

Greetings!

Dr. Iliri

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Brief Answer:
I recommend continuing with the other tests:

Detailed Answer:
Hello again!

Thank you for the information provided.

From her WBC count results that all the types of WBC are elevated and their ratios have not changes. From the other hand, more information on the immature neutrophils (segmentet neutrophils are the old one and their percentage is slightly lower) would give more information.

So the WBC count seems to be related more to inflammation or to an inflammatory response, than to an infection.

Her RBC and Hb are lower than normal ranges, which means she suffers from anemia.

It is necessary to monitor the reticulocytes percentage, to know if this is a regenerative anemia or not.

What about the platelet number?

Regarding the other performed blood tests, they seem to be just normal.

I recommend continuing with the other above mentioned tests.

A direct microscopy of the blood cells from a specialized doctor would help detect possible immature WBC which would be indicative for a bone marrow disorder, though it is less probable with this WBC formula.

Hope to have been helpful!

Best regards,

Dr. Iliri

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