Q: My mother is suffering from raised TLC counts but there is no infection found in her body. The doctor has not prescribed any medicine but she is becoming weaker by the day. What medicines and tests does she require?

A:White blood cells in the blood (leukocytes) comprise granulocytes (cells with granules in their cytoplasm) and mononuclear cells. Granulocytes are of three types – neutrophils, eosinophils and basophils while mononuclear cells are lymphocytes and monocytes. The normal total leukocyte (white blood cells or WBCs) count varies with the age of a person. It also has a diurnal cycle, i.e. counts vary during a 24-hour day. Normally, they range from 4000 to 10,000 per ml in an adult. Leukocytosis is an increase above the accepted normal range of total leukocytes. Usually only one type of cell is responsible for this increase or decrease, but there may be a simultaneous increase / decrease 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 an increase or decrease 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.