Is a White Blood Cell Count of 19.5 Indicative of Bacterial Infection?

A white blood cell count of 19.5 may indicate a bacterial infection, but it is not definitive on its own. Elevated white blood cell counts can occur due to various reasons, including infections, inflammation, stress, or other medical conditions. Further evaluation, including clinical symptoms and additional laboratory tests, is necessary to determine the underlying cause?

Hello Dr.
Lin, a family member has cancer and during a blood test, the white blood cell count was 19.5, lymphocytes were 4.0, and neutrophils were 86.0.
They are experiencing recurrent fever and chills.
When consulting with the doctor, it was mentioned that this is tumor fever, and Naproxen was prescribed for them, but they are still having recurrent fevers.

Miss Hong, 20~29 year old female. Ask Date: 2022/05/21

Dr. Lin Wufu reply Internal Medicine

Hello, it's not possible to distinguish this way! The tumor itself can cause an increase in white blood cells and fever, but infections can also do the same.
Therefore, it ultimately relies on the clinical judgment of the physician; the laboratory data alone cannot differentiate between the two.
On this matter, oncologists have a lot of experience, so it's advisable to follow the physician's prescribed treatment and observe the situation.

Reply Date: 2022/05/21

More Info

A white blood cell (WBC) count of 19.5 is indeed elevated and can suggest the presence of an infection; however, it is essential to consider the broader clinical context before jumping to conclusions. In your case, the patient has a history of cancer, which complicates the interpretation of the elevated WBC count.
White blood cells are a crucial component of the immune system, and their primary function is to fight infections. The normal range for WBC counts typically falls between 4.0 to 11.0 x 10^9/L. A count of 19.5 x 10^9/L indicates leukocytosis, which can occur due to various reasons, including infections, inflammation, stress, and malignancies. In patients with cancer, elevated WBC counts can be attributed to tumor-related factors, such as tumor fever or the body's response to the malignancy itself, rather than an infectious process.

In your specific situation, the breakdown of the WBC differential shows that lymphocytes are at 4.0 (which seems low given the context) and neutrophils at 86.0%. This neutrophilia (high neutrophil count) can often indicate a bacterial infection, but it can also be a response to the cancer itself or other non-infectious causes. The presence of recurrent fevers and chills raises concern for possible infection, but it is also consistent with what is known as "tumor fever," a phenomenon where cancer can cause systemic symptoms like fever without an infectious etiology.

The physician's decision to prescribe Naproxen suggests an attempt to manage the fever and associated discomfort. However, if the fever persists despite medication, further investigation is warranted. This could include imaging studies, cultures, or other diagnostic tests to rule out infections such as pneumonia, urinary tract infections, or other sources of sepsis, especially in an immunocompromised patient due to cancer.

In summary, while a WBC count of 19.5 can indicate a bacterial infection, in the context of a cancer patient, it is not definitive. The elevated count could be due to the cancer itself or an inflammatory response. Continuous monitoring and further diagnostic evaluation are crucial to determine the underlying cause of the elevated WBC count and the recurrent fever. It is essential to maintain close communication with the healthcare team to ensure appropriate management and intervention based on the evolving clinical picture.

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