Dr. Roach: Treating an elevated white blood cell count
Dear Dr. Roach: I am a male, 84 years old and in pretty good health. The only problems I have are high blood pressure and cholesterol, which are under control. I see my primary doctor every six months, at which time he has me do a blood draw, and during the visits he discusses the results with me. During the past two visits, my white blood cell count has been somewhat elevated. As I recall, he said a count below 10,000 is within standard, and mine is slightly high at 10,700. He is concerned about this, since he said it could lead to serious problems if it keeps climbing.
What causes it, and is there anything I can do? Are there any meds that might keep the white blood cell count from climbing?
Dear R.L.H.: “Leukocytosis” is the Greek word we use to describe elevated white blood cell counts. In my hospital’s laboratory, the normal range is from 3,500 to 11,000, so yours wouldn’t be considered elevated. “Normal” in this context means that 95 percent of the healthy population is within that range, which implies that about 2.5 percent of healthy people will have a white blood cell count over 11,000.
Many conditions cause the WBC count to increase temporarily, especially infection. However, if the condition is persistent, then the first step in understanding why is to determine which type of white blood cells has increased. The most plentiful WBCs normally are the lymphocytes and the granulocytes (the others, monocytes, basophils and eosinophils, are very rarely the cause for a leukocytosis). Infection typically causes an increase in granulocytes. High numbers of lymphocytes are seen in certain infections such as acute mononucleosis, but also in myeloproliferative disorders, like the leukemias.
Given your mild elevation, I don’t think there is anything you need to do; the likelihood of this being a serious condition is small. If the level keeps climbing, your doctor will do some further testing or will refer you to hematologist, who will try to find out the underlying cause of the leukocytosis. Only when that is known can treatment be recommended.
Dear Dr. Roach: I am a healthy 65-year-old man, who is 6 feet tall and weighs 185 pounds. I am active, eat well, work part-time outdoors, go to the gym three times per week and take no meds. For the past year or so, four or five nights per week I wake up at night drenched in sweat from my chest to my waist. I have to change my T-shirt and sometimes have to put a towel underneath me because the sheet is damp. This will last for a week or two, then cease. Then it will start up again at another time. What’s up?
Dear R.I.: The condition of night sweats is not uncommon. There are many causes, and although we worry about chronic infections (such as tuberculosis) and malignancies (such as lymphoma), the fact that it has been going on this long with you feeling so well suggests that you may have a more benign cause. Sometimes no cause is found. However, you should see your doctor, who might be able to find the cause after a careful history and physical exam. Checking to see if you have a fever during the episode of sweating will help your doctor narrow the search.
If the answer isn’t obvious, your doctor also may look for some uncommon causes, such as pheochromocytoma, carcinoid syndrome, diabetes insipidus and hyperthyroidism.
Email questions to ToYourGoodHealth@med.cornell.edu.