My patient, a 70-something male, was admitted for GI bleed due to Mallory-Weiss tear. He had been feeling nauseous in the morning and vomited his coffee, and felt a little better (no hematemesis at that time). Many hours later in the day he started feeling worse, and that is when he vomited large amounts of blood. I suspect the MW tear happened during the first vomiting episode (though this is not known for sure) thus causing the subsequent hematemesis. His hct hit a low of 22 (down from 39) before transfusion the next day.
The thing that is perplexing me the most though is his WBC. He had a WBC of 19 later that evening (PRIOR to transfusion). He has no other risk factors to account for this. No known infections, no other illnesses besides whatever made him vomit, no significant leukocytosis inducing meds. No diff was done, and the physician didn't address the high WBCs in any of his notes. Could whatever caused the patient to vomit in the first place (before the tear happened) be what caused the high WBCs? I.e. could a virus or gastritis be enough to make the WBC that high? Maybe the virus/ bacterial illness plus the physical and psychological stress of being acutely ill? I can't find anywhere what the expected values would be for these conditions, but 19 is higher than what my septic patient the previous week had.
I don't have to come up with an answer for my clinical paper, but I would like to be able to explain this better. Thoughts? Would a WBC be this highly elevated due to a simple stomach virus or bacterial infection?
