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What could be the cause for increase in TLC count when suffering from typhoid and knee pain?

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Internal Medicine Specialist
Practicing since : 2007
Answered : 206 Questions
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Hi my mother's TLC count was 10000 on 28th dec2013 11000 on 2jan 2014 and 15000 on 8th january2014. She was suffering from typhoid about 20 days back. She is also having knee pain and BP. She is having medicine for knee pain I.e. rosehip powder and some BP medicine. Why is TLC count increasing. What checkup should I undergo
Posted Wed, 12 Feb 2014 in Medicines and Side Effects
 
 
Answered by Dr. Kavita Paul 2 hours later
Brief Answer: Rapidly rising TLC indicates active infection Detailed Answer: Hi, I appreciate your concern. I think your mother is suffering from a active infection in her body which might to be due to various causes. Your mother needs urgent evaluation for the cause of high TLC. Monitor her body temperature.Watch for warning signs like nausea, vomiting, pain abdomen , fever , breathlessness, decreased urine output or drowsiness. She requires blood investigations like complete blood counts, urine examination, renal amd liver functions, blood culture and chest X ray alongwith antibiotics.Meanwhile continue her other medications. Hope it helps. If you need any clarification please ask.
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Follow-up: What could be the cause for increase in TLC count when suffering from typhoid and knee pain? 14 hours later
Thanks Dr. I am enclosing blood and urine test performed on dated 14.12.13/03.01.14/08.01.14 (NC = Not Checked) 1. TLC = 10000/11000/15200 2.S.URIC ACIS = 7/3.2/ NC 3.B.SUGAR = 80/NC/NC 4. S.CHOLESTROL=180/NC/NC 5.S.BILUR= 0.6/NC/NC 6.WIDAL IGM = +VE/ +VE / NC IGG = +VE/ +VE / NC 7. URINE ALBUMIN = NIL/ NIL / NIL BILE SALT= NIL/ NIL / NIL EPITHELIAL CELLS = NIL/ + / NIL CRYSTALS = NIL/ NIL / NIL SUGAR = NIL/ NIL / NIL BILE PIGMENT = NIL/ NIL / NIL PUS CELLS = 8-10/60-70/0-1 RBC = 2-4/ 0-1 / NIL CASTS = NIL/ NIL / NIL THE MEDICINES WHICH DOCTOR HAD PTESCRIBED YESTERDAY IS 1. CAP OMIDIL D (OMEPRAZOLE & DOMEPERIDONE) 2. TAB LOSAN A (LOSARTAN POTASSIUM & AMLODIPINE) 3.TAB ALTACEF-CV (CEFUROXIME & CLAVULANIC ACID) 4.CAP ROSIFLEX(FOR KNEES) 5. TC 550 ( VITAMIN E & C) 6. ARTISAFE ( ARTEMETHER 80mg & Lumefantrine 480mg) Kindly guide what other tests(in detail) should I undergo. I am little worried so kindly help.
 
 
Answered by Dr. Kavita Paul 3 hours later
Brief Answer: continue the prescribed treatment Detailed Answer: Hi, I think so that you should continue the above prescribed treatment. She seems to be suffering from Urinary tract infection alongwith enteric fever. Kindly continue the above prescribed medications for 3 to 5 days and then repeat her blood counts and urine examination.Meanwhile give her lots of fluids and watch her urine output. Cranberry juice is also helpful. In case there is no response, then get her renal function tests, urine culture & senstivity and ultrasound KUB. Hope it helps. . Dr. Kavita Paul
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Follow-up: What could be the cause for increase in TLC count when suffering from typhoid and knee pain? 7 days later
hi i got the following investigations done C-reactive Protein Quantitative Glycosylated Haemoglobin Rational Thyroid panel CBC/, Blood /Smear Culture, Urine with susceptibility Kidney Panel-1 Imaging Us-KUB RAPID TYPHI Test Report Status Preliminary Results Biological Reference Range Units KIDNEY PANEL - 1 BLOOD UREA NITROGEN, SERUM BLOOD UREA NITROGEN 12 (6 - 20 mg/dL) CREATININE, SERUM CREATININE 0.8 0.6 - 1.1 mg/dL METHOD : SPECTROPHOTOMETRY BUN/CREAT RATIO BUN/CREAT RATIO 15.00 5.00 - 15.00 METHOD : CALCULATED PARAMETER URIC ACID, SERUM URIC ACID 4.9 2.6 - 6.0 mg/dL METHOD : SPECTROPHOTOMETRY TOTAL PROTEIN, SERUM TOTAL PROTEIN 8.0 6.4 - 8.2 g/dL METHOD : SPECTROPHOTOMETRY ALBUMIN, SERUM ALBUMIN 3.7 3.4 - 5.0 g/dL METHOD : SPECTROPHOTOMETRY GLOBULIN GLOBULIN 4.3 High 2.0 - 4.1 g/dL METHOD : CALCULATED PARAMETER ELECTROLYTES (NA/K/CL), SERUM SODIUM 139 136 - 145 mmol/L METHOD : SPECTROPHOTOMETRY POTASSIUM 4.00 3.50 - 5.10 mmol/L METHOD : SPECTROPHOTOMETRY CHLORIDE 102 98 - 107 mmol/L URINALYSIS COLOR PALE YELLOW APPEARANCE CLEAR PH 6.0 4.7 - 7.5 SPECIFIC GRAVITY 1.010 1.003 - 1.035 GLUCOSE NOT DETECTED NOT DETECTED PROTEIN NOT DETECTED NOT DETECTED KETONES NOT DETECTED NOT DETECTED BLOOD NOT DETECTED NOT DETECTED Test Report Status Preliminary Results Biological Reference Range Units BILIRUBIN NOT DETECTED NOT DETECTED UROBILINOGEN NORMAL NORMAL NITRITE NOT DETECTED NOT DETECTED WBC 1-2 0-5 /HPF EPITHELIAL CELLS 2-3 0-5 /HPF RED BLOOD CELLS NOT DETECTED NOT DETECTED /HPF CASTS NOT DETECTED NOT DETECTED CRYSTALS NOT DETECTED NOT DETECTED BACTERIA NOT DETECTED NOT DETECTED HAEMATOLOGY COMPLETE BLOOD COUNT, EDTA WHOLE BLOOD/SMEAR COMPLETE BLOOD COUNT RED BLOOD CELL COUNT 4.34 3.8 - 4.8 mil/μL HEMOGLOBIN 11.9 Low 12.0 - 15.0 g/dL METHOD : CELL COUNTER HEMATOCRIT 38.5 36 - 46 % METHOD : CELL COUNTER MEAN CORPUSCULAR VOL 88.7 83.0 - 101.0 fL MEAN CORPUSCULAR HGB. 27.4 27.0 - 32.0 pg MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION 30.9 Low 31.5 - 34.5 g/dL RED CELL DISTRIBUTION WIDTH 13.6 11.6 - 14.0 % PLATELET COUNT 198 150 - 410 thou/μL MEAN PLATELET VOLUME 11.8 High 6.8 - 10.9 fL WHITE BLOOD CELL COUNT 11.6 High 4.0 - 10.0 thou/μL METHOD : CELL COUNTER WBC DIFFERENTIAL COUNT SEGMENTED NEUTROPHILS 82 High 40 - 80 % EOSINOPHILS 02 1 - 6 % LYMPHOCYTES 14 Low 20 - 40 % MONOCYTES 02 2 - 10 % CLINICAL INFORMATION : Test Report Status Preliminary Results Biological Reference Range BASOPHILS 00 < 1 - 2 % BIO CHEMISTRY GLYCOSYLATED HEMOGLOBIN, EDTA WHOLE BLOOD GLYCOSYLATED HEMOGLOBIN (HBA1C) 6.2 Non-diabetic: < 5.7 Pre-diabetics: 5.7 - 6.4 Diabetics: > or = 6.5 ADA Target: 7.0 Action suggested: > 8.0 High % METHOD : HPLC MEAN PLASMA GLUCOSE 131.2 High < 116.0 mg/dL NEPHELOMETRY C-REACTIVE PROTEIN, SERUM (QUANTITATIVE) C-REACTIVE PROTEIN 22.0 High 0 - 3 mg/L METHOD : SPECTROPHOTOMETRY ENDOCRINOLOGY RATIONAL THYROID PANEL, SERUM TSH 3RD GENERATION ULTRA (TSH3 - UL) TSH 3RD GENERATION 1.050 0.27 - 4.20 μIU/mL Test Method(s) TSH 3RD GENERATION ULTRA (TSH3 - UL)- MICRO BIOLOGY CULTURE, URINE WITH SUSCEPTIBILITY CULTURE; URINE SPECIMEN SOURCE URINE METHOD : MANUAL POLYMORPHO NUCLEAR LEUKOCYTES NOT DETECTED /HPF RED BLOOD CELLS NOT DETECTED /HPF EPITHELIAL CELLS NOT DETECTED /HPF BACTERIA NOT DETECTED Test Report Status Preliminary Results Biological Reference Range FUNGAL ELEMENTS NOT DETECTED CULTURE NEGATIVE METHOD : CULTURE REMARK CULTURE IS STERILE AFTER 24 HOURS OF INCUBATION Rapid TYPHI IGM RAPID TYPHI IGM NOT DETECTED NOT DETECTED Dr. XXXXXXX XXXXXXX MD, PDCC Pathologist Dr. XXXXXXX Garg, MD Consultant Dr. XXXXXXX XXXXXXX MD Consultant US-KUB Right Kidney 9.6X3.8cm Left Kidney 10.5X4.4cm Both kidneys are normal in size, shape position and echopattern. No calculus or hydronephrosis is seen. cortical thickness is normal. corticomedullary is maintained. the bladder is well distended and shows echofree lumen. No calculus /thickening seen. THE DOCTOR PRESCRIBED FOLLOWING MEDICINES and I discontinued the earlier medicines now my mother is suffering from high fever earlier she was not haviing fever Tab Losar-A Tab Thyronom 100 Tab Martifur 100 Tab Supradyn Tab Crocin(in case of fever) KIndly help
 
 
Answered by Dr. Kavita Paul 1 hour later
Brief Answer: High TLC is mist probably due to septicaemia Detailed Answer: Hi, I appreciate the effort you are making to help your mother. Since your mother is having fever with high TLC,she seems to be suffering from septicaemia. Her urine routine and culture are negative and US KUB is showing no evidence of abscess or pyelonephritis.Her Blood sugars are high , kindly repeat it in fasting stage.Serum globulins are little bit high,So kindly get her fasting ESR,Serum Protein Electrophoresis and Skull X Ray -Lateral view and Chest Xray-PA View.Meanwhile continue her antibiotics and monitor her fever regularly(esp. for any evening rise of temperature).Watch her appetite and monitor her weight .In case her fever persists,then she might need IV antibiotics and hospitalization. Hope it helps, Dr. Kavita Paul
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Follow-up: What could be the cause for increase in TLC count when suffering from typhoid and knee pain? 24 hours later
How could you say it is septicaemia as the TLC were 15200 on 08.1.14 and White Blood Cell on 13.1.14 was 11.6 it has reduced. My mother was not having high fever till 13.1.14 till she was having the earlier prescribed medicine. What tests should be performed to check septicaemia. Kindly revert soon
 
 
Answered by Dr. Kavita Paul 15 hours later
Brief Answer: continue antibiotics Detailed Answer: Hi, I think you mentioned in your last question, that your mother is having fever with TLC 11000 . We say Septicaemia when patient has high TLC with Fever etc. In case your mother is having no fever with decreasing TLC , then you should not worry. Continue her antibiotics. In case she is still having fever, then I would be concerned and order the aforementioned investigations. Regards
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Follow-up: What could be the cause for increase in TLC count when suffering from typhoid and knee pain? 5 days later
DEAR MAM I HAVE GOT CHEST AND SKULL XRAYS DONE. PLEASE FIND ATTACHED FILES. TLC COUNT WERE 13600 ON 21.01.14 AND SHE IS NOT HAVING FEVER OR JUST MILD FEVER ONCE OR TWICE IN A DAY. KINDLY GO THRU THE XRAY REPORTS
 
 
Answered by Dr. Kavita Paul 33 minutes later
Brief Answer: Grossly no abnormality Detailed Answer: Hi, I hope your mother is in good health now. I had a look at your X Rays,though the images were not of very good quality,but grossly i could not seen any lytic lesions or any other abnormality in skull X Ray. The Chest X Ray is not showing any evidence of active infection. I would advise you to please attach in radiologist reporting of X Rays ,if possible. Dr. Kavita Paul
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