infection and normal WBC

Nurses General Nursing

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Hi!

Just wondering why a WBC would be normal in the presence of an infection. This particular patient was admitted with cellulitis. His labs are 5.3 (4.2-10.5). So not even close to being high. All numbers in the differential are WNL. Is it just a matter of time before the WBC is too high? or what? Thanks :-)

Specializes in assisted living.

oh, and no steroids either :-)

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Again I would say that there may not be an infection present. Just because you get a positive culture doesn't mean there is an infection. If we swabbed your hand we might grow strep, but that doesn't mean your hand is infected with strep (colonization vs. infection). This is also the difference between SIRS and sepsis; you can have SIRS with no infection. SIRS + infection = sepsis.

If the WBC were on their way down due to SIRS/sepsis your would expect bands and even some metamyleocytes. This is not the case.

A platelet drop from 240 to 200 doesn't concern me terribly. A drop from 500 to 200 would, or if the count continues to drop.

Patient on any other meds, or just abx? What abx is he on?

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Specializes in assisted living.

Hi xtrn!

Yes, several open wounds that cultured positive for strep. I have never seen cellulitis before. very interesting! This patient has chronic lymphedema and currently has significantly swollen lower legs- like nothing I have ever seen before. It just must not be as serious if he has already gone home by today. He also doesn't have any dx would indicate he is immunocompromised. Also I saw all of his labs...no blood cultures, just the WBC. I wonder why they wouldn't test for this...

That is something that frustrates me...I have a patient for a day or two in clinicals and I am left wondering so much! There just isn't enough time to ask all of my questions while at clinicals or I come home and all of these questions come to me. I spend so much time looking things up, but then I never know if I have found the right answers! So that brings me to this site so that I can ask people with experience. Thanks again!

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I would suspect the patient has inflammatory cellulitis secondary to the lymphedema. Abx are Rx because of the decreased barrier integrity and likelihood of infection. Like another poster said, the bacteria haven't solicited a WBC response, likely because there isn't a technical infection yet.

No blood cultures because patient isn't septic. Blood cultures would be negative.

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a great read.

Cellulitis Workup

i'm linking the lab/workup page only because it mentions those with lymphedema, necessitating diff considerations.

http://emedicine.medscape.com/article/214222-workup#aw2aab6b5b2

leslie

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Specializes in assisted living.

Thanks Leslie!!

One last question...you said no blood cultures because the patient isn't septic, but isn't that how they would diagnose if the patient is septic? I am just thinking about the previous posts that said that if WBC is normal, cultures may be done to rule out sepsis....why wouldn't they have done that with him?

Thanks :-)

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If there was bacteremia you would expect changes in the diff (bands at the very least, but frequently if WBC on way back down, P would be neutropenic/low normal neuts and you would see metamyelocytes due to severe left shift), as that is an advanced stage of infection. No diff changes = bacteremia/sepsis very very unlikely = blood cultures waste of time and money.

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Specializes in assisted living.

Thanks!!! So much good info!

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Hi Clearblue3;

I just happened to come across this post by you (much time has elapsed since you posted it), regarding normal WBC count when an infection is present. I am not in the medical profession, but am a patient who had that exact thing happen to me, in January of 2010. My right shin area was swollen to twice its size and was extremely painful, and I went to ER with vomiting occurring. I was admitted and given antibiotics (AB), which did not do anything. I guess the expectation was that the AB combined with my immune system would end the infection ... turns out my WBC count was normal because they were basically sitting around ignoring the infection. I was in hospital for 25 days ... it wasn't until I had a bone marrow aspiration that the reason was discovered ... a condition called "Monoclonal Gammopathy" (or so I was informed). For some reason the white blood cells had only one target they were looking for, and ignoring all others. The AB dosage was increased dramatically, because it was doing all the work by itself, and the infection was final gotten under control (but not without a fair amount of damage to the leg area). Might be something to stick in your notes for future reference ... you never know.

Take care, and keep up the GREAT work ... Pete Dowan

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This is very interesting to me considering I was just wondering this for myself. I have a severe intestinal infection that has inflamed my bowels and appendix along side a kidney stone and my doctor missed it for two days due to a normal WBC count. Why would my white count never be affected.

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Specializes in Critical Care/Vascular Access.

interesting thread. I've learned a few very useful things reading through this. thanks to all replies and the OP for the good question.

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Specializes in Medical and general practice now LTC.
This is very interesting to me considering I was just wondering this for myself. I have a severe intestinal infection that has inflamed my bowels and appendix along side a kidney stone and my doctor missed it for two days due to a normal WBC count. Why would my white count never be affected.

We can't as per the Terms of Service of the site offer medical advice you really need to speak to your doctor

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