What Causes High TLC Count?

Posted on Tue, 7 Jan 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 7 Jan 2014 Answered on

Thu, 30 Jan 2014 Last reviewed on

Question : Hi, My mother has high TLC count of 18700 seems to be increasing(initially 16400). Her age is 64. We got her few blood test, urine routine, urine culture, ultrasound of lower abdomen, heart echo, blood urea:35, creatinine: 0.95. All reports are normal. Her blood sugar level is also normal. As of now, we have given her blood sample for blood culture. She has no feeling of fever or any illness and working in her day-to-day activities normally. In November month, she was admitted to hospital and was given intravenous medicines to control TLC. But its seems to be increasing again. My mother TLC has increased by 2000 (approx) from 16400 to 18700 in almost 1 week and may be the number has kept increasing since time of discharge at November'13 end. I can submit her blood culture report due to be received by 9th Jan'14 or upload any relevant reports that you would need to review. During her hospitalization, Doctors did not do CT scan or bone marrow test as TLC came to normal with medication.

Answered by Dr. Indranil Ghosh (56 minutes later)

Brief Answer: Please refer below Detailed Answer: Dear Mr XXXXXXX Thanks for your query. As per the blood report, the neutrophils are the cells which appear to be increasing. These cells are usually raised in response to some infection. But she does not have any symptom or focus of infection it seems. Hence it is quite perplexing why this is increasing. It may be a good idea to keep a watch on the increase and if it does not stabilise, then evaluating the blood smear by an experienced hematopathologist may be justified. This is to rule out any evidence of bone marrow proliferative disorder. Then we can go for bone marrow or CT scans if required. Hope I have answered your query. I will be available to answer further followup queries, if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (2 days later)

Hello Dr. Indranil, We have tested TLC again yesterday and it again slightly increased from 18700 to 19200 now (in 4 days). We have given blood sample for Peripheral Blood Smear test and I would share the report with you once I get the results. Regards.

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer: Okay Detailed Answer: Please send me the report when ready.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (2 hours later)

Hi Dr Indranil, I have uploaded the TLC and Blood smear report of todays sample. TLC count today is 18200 (10th Jan'14) while yesterday it was 19200 (9th Jan'14). While on Monday (6th Jan'14) it was 18700.

Answered by Dr. Indranil Ghosh (4 hours later)

Brief Answer: Please refer below Detailed Answer: Only the neutrophils are high. You can ask the pathologist if there was any left shift or not. Left shift indicates some infection. Otherwise we may just observe the counts. Unless it rises significantly from the current level, there may not be anything serious.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (25 hours later)

Thanks Dr Indranil, We have gone for 3 days of consecutive TLC 09th Jan'14, Thursday - TLC 19200 10th Jan'14, Friday - TLC 18200 11th Jan'14, Saturday - TLC - 19000 I'm attaching report (reportpdf.pdf) for your reference which includes another two tests (Procalcitonin and Urine Routine). As of now, there is no fever or any symptom.

Answered by Dr. Indranil Ghosh (29 minutes later)

Brief Answer: Looks ok Detailed Answer: only thing is the protein in urine, which is likely due to the longstanding diabetes. Otherwise only the TLC is high. May be observed I believe.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (36 hours later)

Thanks Dr Indranil, For how long should we monitor TLC or should we re-test every month to ensure that its not rising? Could this be caused by allergy, are there any allergy tests available through which we know its cause for rise?

Answered by Dr. Indranil Ghosh (2 hours later)

Brief Answer: allergy can raise eosinophils, not neutrophils Detailed Answer: So allergy tests will not help. We can do CBC every month unless she develops some new symptoms.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar