Elevated White Blood Cell and Eosinophil Counts: What to Do Next?

Q: Elevated White Blood Cell and Eosinophil Counts: What to Do Next?

Hello： According to your test results, your white blood cell count and eosinophil levels have been elevated for some time, but there has been no continuous worsening of your condition. <br>If you are not experiencing any significant discomfort, you may consider monitoring and obs

White blood cell-related issues..?

Hello Dr.
Lin,
I previously consulted you regarding related issues, and I appreciate your response.

================== Below are the blood test results from March ==================
WBC (White Blood Cells) Report: 16.47 (Reference Range: 3.90–10.60)
RBC (Red Blood Cells) Report: 5.04 (Reference Range: 4.50–5.90)
Hb (Hemoglobin) Report: 16.5 (Reference Range: 13.5–17.5)
Hct (Hematocrit) Report: 47.0 (Reference Range: 41.0–53.0)
MCV (Mean Corpuscular Volume) Report: 93.3 (Reference Range: 80.0–100.0)
MCH (Mean Corpuscular Hemoglobin) Report: 32.7 (Reference Range: 26.0–34.0)
MCHC (Mean Corpuscular Hemoglobin Concentration) Report: 35.1 (Reference Range: 31.0–37.0)
Platelet Report: 405 (Reference Range: 150–400)
RDW (Red Cell Distribution Width) Report: 13.6 (Reference Range: 11.5–14.5)
Neutrophil Report: 50.5 (Reference Range: 40.0–74.0)
Lymphocyte Report: 30.5 (Reference Range: 19.0–48.0)
Monocyte Report: 5.7 (Reference Range: 3.4–9.0)
Eosinophil Report: 13.3 (Reference Range: 0.0–7.0)
Basophil Report: 0.0 (Reference Range: 0.0–1.5)
NRBC (Nucleated Red Blood Cells) Report: 0.0 (Reference Range: 0.0–2.0)
Atypical Lymphocyte Report: 0.0 (Reference Range: 0.0)
Band Neutrophil Report: 0.0 (Reference Range: 0.0)
Metamyelocyte Report: 0.0 (Reference Range: 0.0)
Myelocyte Report: 0.0 (Reference Range: 0.0)
Promyelocyte Report: 0.0 (Reference Range: 0.0)
Blast Report: 0.0 (Reference Range: 0.0)
================== Below are the blood test results from July ==================
WBC (White Blood Cells) Report: 14.22 (Reference Range: 3.90–10.60)
RBC (Red Blood Cells) Report: 5.14 (Reference Range: 4.50–5.90)
Hb (Hemoglobin) Report: 16.3 (Reference Range: 13.5–17.5)
Hct (Hematocrit) Report: 47.5 (Reference Range: 41.0–53.0)
MCV (Mean Corpuscular Volume) Report: 92.4 (Reference Range: 80.0–100.0)
MCH (Mean Corpuscular Hemoglobin) Report: 31.7 (Reference Range: 26.0–34.0)
MCHC (Mean Corpuscular Hemoglobin Concentration) Report: 34.3 (Reference Range: 31.0–37.0)
Platelet Report: 380 (Reference Range: 150–400)
RDW (Red Cell Distribution Width) Report: 13.5 (Reference Range: 11.5–14.5)
Neutrophil Report: 54.7 (Reference Range: 40.0–74.0)
Lymphocyte Report: 21.7 (Reference Range: 19.0–48.0)
Monocyte Report: 6.6 (Reference Range: 3.4–9.0)
Eosinophil Report: 17.0 (Reference Range: 0.0–7.0)
Basophil Report: 0.0 (Reference Range: 0.0–1.5)
NRBC (Nucleated Red Blood Cells) Report: 0.0 (Reference Range: 0.0–2.0)
Atypical Lymphocyte Report: 0.0 (Reference Range: 0.0)
Band Neutrophil Report: 0.0 (Reference Range: 0.0)
Metamyelocyte Report: 0.0 (Reference Range: 0.0)
Myelocyte Report: 0.0 (Reference Range: 0.0)
Promyelocyte Report: 0.0 (Reference Range: 0.0)
Blast Report: 0.0 (Reference Range: 0.0)
================== Below are the general biochemical test results from July ==================
GOT (AST) Report: 24 (Reference Range: 5–35)
GPT (ALT) Report: 37 (Reference Range: 5–35)
γ-GT Report: 65 (Reference Range: 8–50)
Creatinine (B) Report: 1.11 (Reference Range: 0.50–1.30)
eGFR Report: 74.23 (Reference Range: ≥60.00)
================== Below are the urine test results from July ==================
Bilirubin Report: 1+ (Reference Range: Negative)
Ketone Report: Trace (Reference Range: Negative)
Protein Report: 1+ (Reference Range: Negative @ Trace)
Bacteria Report: Positive (Reference Range: Negative)
In the March blood test report, aside from the WBC count of 16.47, there were also eosinophils at 13.3 and platelets at 405.
The rest were within normal ranges.
In the July blood test report, aside from the WBC count of 14.22, there were also eosinophils at 17.0.
The rest were within normal ranges.
The general biochemical test report and urine test report from July showed issues as indicated above.
The doctor mentioned that the problematic areas in the blood reports over the past few years (about 2–4 years) have been similar.
The general biochemical test report and urine test report from July seem to indicate that the kidneys have reached their limit.

May I ask if leukocytosis and eosinophilia are valid diagnoses? Can they be ignored? Are my kidneys really in danger of failure? What should I do next? I feel a bit confused.
I kindly ask for your guidance, Dr.
Lin.
Thank you, and I wish you peace and joy.

Mr. Cheng, 50~59 year old female. Ask Date: 2022/08/03

Dr. Lin Zhebin reply Family Medicine

Hello: According to your test results, your white blood cell count and eosinophil levels have been elevated for some time, but there has been no continuous worsening of your condition.
If you are not experiencing any significant discomfort, you may consider monitoring and observation.
Additionally, regarding your urine test results, there is concern about the possibility of a urinary tract infection and kidney disease.
It is recommended that you consult a nephrologist for further evaluation and treatment.

Reply Date: 2022/08/03

More Info

Elevated white blood cell (WBC) counts, particularly eosinophils, can be concerning and warrant further investigation. In your case, the blood test results show a WBC count of 16.47 (normal range: 3.90–10.60) and eosinophils at 13.3 (normal range: 0.0–7.0) in March, and 17.0 in July. These elevated levels indicate a potential underlying issue that needs to be addressed.

Understanding Elevated WBC and Eosinophil Counts
1. Eosinophils: Eosinophils are a type of white blood cell primarily involved in the body's response to allergens, parasites, and certain infections. An elevated eosinophil count, known as eosinophilia, can be caused by various factors, including:
- Allergic reactions (e.g., asthma, hay fever)
- Parasitic infections (e.g., helminths)
- Autoimmune diseases (e.g., lupus)
- Certain cancers (e.g., Hodgkin's lymphoma)
- Drug reactions
2. Total WBC Count: A high total WBC count can indicate several conditions, including infections, inflammation, stress responses, or more serious conditions like leukemia. The fact that your WBC count has been consistently elevated over the past few months suggests that further evaluation is necessary.

Next Steps
1. Consult a Hematologist: Given the persistent elevation in your WBC and eosinophil counts, it is crucial to consult a hematologist. They can perform a thorough evaluation, including a complete blood count (CBC) with differential, bone marrow biopsy if necessary, and other specific tests to determine the underlying cause.

2. Further Testing: Your physician may recommend additional tests such as:
- Bone Marrow Biopsy: This is essential if there is a suspicion of hematological disorders, including leukemia or myelodysplastic syndromes (MDS).

- Allergy Testing: If an allergic reaction is suspected, allergy testing can help identify specific triggers.

- Parasitic Infection Screening: If there is a possibility of a parasitic infection, appropriate tests should be conducted.

3. Monitor Symptoms: Keep track of any symptoms you may be experiencing, such as unexplained weight loss, fever, night sweats, or fatigue. These symptoms can provide valuable information to your healthcare provider.

4. Kidney Function: Your July biochemical report indicates a creatinine level of 1.11 and an eGFR of 74.23, which suggests that your kidney function is still within an acceptable range, but it is on the lower side. The presence of protein and bacteria in your urine could indicate a urinary tract infection or kidney issues. It is essential to follow up with a nephrologist to assess kidney health and determine if any interventions are necessary.

5. Lifestyle Modifications: While awaiting further evaluation, consider adopting a healthy lifestyle that includes:
- A balanced diet rich in fruits, vegetables, whole grains, and lean proteins.

- Regular physical activity to maintain a healthy weight and improve overall health.

- Adequate hydration to support kidney function.

Conclusion
Elevated WBC and eosinophil counts can indicate various underlying health issues, and it is essential to take these findings seriously. Consulting with a hematologist and possibly a nephrologist will provide you with a clearer understanding of your condition and the necessary steps to take. Regular monitoring and lifestyle adjustments can also play a significant role in managing your health. Please do not hesitate to reach out to your healthcare provider for further guidance and support.

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