Q: I have an elevated white blood count for the past 10 months. It ranges from 11,000 to 15,000. My doctor hasn't been able to tell me anything. He has asked me to quit smoking and I have cut down quite a bit. However, 2 years ago I was a smoker and my blood was normal. I have always smoked 1 pack or less per day. What is the cause of sudden change in blood? Should I seek second opinion? The only symptoms I have are tiredness, low fever (sometimes) 99 and recently some minor pain in the right lower corner of my back? Please advise.

A:Leukocytosis refers to an increase in the total number of white blood cells (WBCs) in the blood from any cause. White blood cells 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. An elevated blood cell count or total leukocyte count (TLC) called leukocytosis may be due to an increase in granulocytes, lymphocytes or monocytes and is respectively called absolute neutrophilia (or eosinophilia/basophilia), absolute lymphocytosis and absolute monocytosis. The causes for each of these are many. Leukocytosis is a common laboratory finding and is most often due to relatively benign conditions like infections or inflammatory processes. The normal reaction of bone marrow to infection or inflammation (tissue necrosis, infarction, burns, arthritis) leads to an increase in the number of white blood cells, predominantly polymorphonuclear leukocytes and less mature cell forms. Physical stress caused by overexertion, anesthesia or seizures and emotional stress too can raise the TLC. Some drugs like corticosteroids, lithium and beta agonists too can cause a rise in neutrophils. Increased eosinophil or basophil counts can be due to a variety of infections, allergic reactions or other causes. Lymphocytosis may be caused by acute viral infections (including hepatitis), chronic infections like tuberculosis and lymphoid malignancies (e.g. chronic lymphocytic leukemia). Much less common but more serious causes include primary bone marrow disorders and this is suspected in patients who present with extremely high white blood cell counts or concurrent abnormalities in red blood cell or platelet counts. Weight loss, bleeding or bruising, liver, spleen or lymph node enlargement, and immunosuppression also increase suspicion for a marrow disorder. This group of bone marrow disorders includes acute leukemias, chronic leukemias and myeloproliferative disorders. The elevated TLC needs to be viewed in the light of the clinical profile. Please consult a hematologist and get a complete blood count with a peripheral blood film review. This would help decide if further investigations (like a bone marrow examination) are warranted.