What do elevated TLC, ESR and lymphocytes indicate?
Answered by: Dr Shirish Kumar
| Haematologist,
WHO,
Geneva
Q: What does higher ESR and lymphocytes in blood test indicate? If the total leukocytes count drop from 70000 to 6300 in a months time, does it require any medical attention?
A:Erythrocyte Sedimentation Rate (ESR) is the rate at which the red blood cells settle down or fall to the bottom when placed in a tube. It is measured in millimetres per hour. It is a very non-specific indicator of the presence of disease - i.e., it doesn't point to any one particular illness but to a variety of possibilities. In certain illnesses the red blood cells become coated with a layer of protein which makes them stick together in columns and fall faster down the tube (giving a higher result on the test). Age, pregnancy, anaemia and disease raise it.
The rough normal value for adult males is their age in years divided by 2, or below while the normal for women is age + 10 divided by 2, or below.
Some common causes for elevated ESR are:
Acute inflammation
Severe or chronic infections (acute bacterial infections, tuberculosis etc.)
Connective tissue diseases - systemic lupus erythematosus (SLE), giant cell arteritis, systemic sclerosis etc.
Cancer
Rheumatoid arthritis
Kidney disease
When serial tests are performed on a patient, there are many possible reasons for unanticipated discrepant results. Some are associated with preparations for and conditions of testing (pre analytic variation), some with the test procedures themselves (analytic variation), and some with biologic variations in the individual patient.
Pre analytic factors that may influence test results include patient preparation and positioning, type of specimen (venous or capillary), type of collection tube used, and specimen transport and storage. Leaving a tourniquet in place for a few minutes longer than usual during blood sampling may cause standard tests to vary significantly. Simple factors such as position of the patient (sitting versus lying), movement, or exercise can also cause laboratory values of some analytes to differ significantly. It is therefore advised that specimen should be drawn in a consistent fashion after the patient has been either lying or sitting quietly for at least 5 minutes.
Intraindividual variation can occur within the same day or from one day to another. Haemoglobin, haematocrit, and red blood cell count fluctuations usually repeat on a regular diurnal basis, the morning values typically being highest. Mean leukocyte counts are usually highest in the afternoon. In one large study, the individual variation in total leukocyte count was as much as 3.0 X 103/microliters within a single day and as much as 5.0 X 103/microliters over the 3-day period. Similarly, the haemoglobin values showed an intraindividual shift of as much as 1.5 g/dL during the course of a single day and as much as 2.0 g/dL over 3 days.
You will thus note that the two TLC values are within this range and this should cause no concern. Lymphocytes are a type of white blood cells (mononuclear cells) which are responsible for cellular and humoral (antibody) immunity in the body and a change in their value is suggestive of some diseases.
