[CritterLover]

What could cause a newborn's (1 day old) wbc to be so high?

Part of my job is to review abnormal lab results and address certain ones in our adult population.

They all (adult and newborn) print out together on the same sheet, and the other day, I came across these wbc on an infant: 189.1; then about nine hours later, 217.5.

It caused me to be curious as to the source. Sepsis came to mind, but in adults, we don't usually see wbc that high with sepsis. That would be more consistent with leukemia.

Of course, I have absolutely no other information available -- those two white counts and her age are it.

Any thoughts?

[SteveRN21]

Though I've never seen a WBC count that high (89k was the highest I've seen)

There have been a few threads recently that have asked similar questions to yours, and apparently some people have seen WBCs that high.

In my experience, with neonatal sepsis, the WBC count rises to around 30-40k, then shifts dramatically "to the left" with an increasing band count and decreasing segs. With viral sepsis, the WBC ct is usually low.

[Jolie]

A WBC count that hight in a newborn would make me suspect leukemia as well.

[SteveRN21]

Did they list blast cell results as well? High blast cell counts can indicate some type of leukemia.

[CritterLover]

I'm sure the actual lab report has a differential on it (at least for one of the samples), but I'm not privy to it.

I do know the infant is still alive, and she hasn't shown up on any other lab reports -- but I don't know if that means her wbc is now <50,000 (>50k is the point where the wbc prints on my list), or if they haven't rechecked it.

I guess I wasn't sure if leukemia was seen in newborns, and I was wondering if neonatal sepsis caused such high counts.

Thanks for the speculations!

[dawngloves]

Were these corrected values?
I've seen this is a couple of term r/o sepsis kids. It came down to a normal level after a few days.

[prmenrs]

Interesting to know what the C-reactive protein was. Some places don't do them, tho.

[RainDreamer]

It's hard to know anything about what's going on by just looking at the total WBC. ANC? I/T ratio? And like prmenrs mentioned ..... I'd be curious to see what the CRP is too.

[EricEnfermero]

Interesting, but hard to pin down without the diff I think.

There is a congenital leukemia, but it's very rare and it wouldn't really be associated with just a couple of extremely elevated WBC counts.

There is also something called transient myeloproliferative disease (sometimes seen in Down syndrome), but again, the high white count would probably persist for a period of weeks or more.

If it were just one value, I would wonder about some sort of instrument error or sampling issue. Sometimes after the differential, the WBC count is adjusted a little bit to correct for the presence of what were actually nucleated RBC's.