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Is my mother's WBC so high due to bone metastasis?

Q: My mother had breast cancer 6 years back and underwent chemotherapy and radiation. Now she has bone metastasis. She is undergoing chemotherapy again. However, her WBC count is very high at 33000 and the Oncologist says that normally in bone metastasis the WBC counts are not so high. What can be the reason for this? Can she have tuberculosis of bone marrow? How can one test it and what else could be the reason? She has been having low-grade fever (99.4 degree centigrade), which comes in the late afternoon and goes away in the late evening.

A:Leukocytosis is an increase above the accepted normal range of total leukocytes. Usually only one type of cell is responsible for this increase, but there may be a simultaneous increase in several cell types. The counts may go up due to an increase in any component of the white cells i.e. neutrophils (called neutrophilia), lymphocytes (called lymphocytosis), monocytes (called monocytosis), eosinophils (called eosinophilia) or basophils (called basophilia). This can be judged by a differential leukocyte count. The range of each of these cells also varies with the age of an individual. There are numerous causes for increases in neutrophils, lymphocytes etc. The degree of leukocytosis depends upon several factors like its cause, severity of the infection, resistance of the body, localisation of the inflammatory process (greater neutrophilic leukocytosis is produced by a localised disease process rather than a generalised one) and modification by treatment. Pathological leukocytosis is secondary to infection (localised or generalised), tissue necrosis from any cause (infarction, burns, gangrene, neoplasms), metabolic (uraemia, acidosis), chemical intoxication, insect venom, allergic reactions, acute haemorrhage or haemolysis and malignancy (leukaemia). Some drugs like corticosteroids, lithium and beta agonists too can cause a rise in neutrophils. Lymphocytosis may be caused by acute viral infections (including hepatitis), chronic infections like tuberculosis and lymphoid malignancies (e.g. chronic lymphocytic leukaemia). The elevated TLC needs to be viewed in the light of the clinical profile. Please get a complete blood count with a peripheral blood film review.

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