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What Causes Elevated TLC During 28 Weeks Of Pregnancy?
Question: Hello Doctor,
My wife is 28 weeks pregnant. From last one month her TLC (17900) and DLC(85% Neutrophils) count is elevated. At present she is on LMWH+ecospirin & thyronorm. We checked with her Gynac and Physician and they asked for various tests (Urine routine/Culture, Blood Culture, CRP, PCTQ etc) but all the reports are normal. She also had three courses of antibiotics (Cetil, Augumentin, Azelide) but TLC, DLC are still elevated. Please suggest what else we could do? Thank you...XXXX
My wife is 28 weeks pregnant. From last one month her TLC (17900) and DLC(85% Neutrophils) count is elevated. At present she is on LMWH+ecospirin & thyronorm. We checked with her Gynac and Physician and they asked for various tests (Urine routine/Culture, Blood Culture, CRP, PCTQ etc) but all the reports are normal. She also had three courses of antibiotics (Cetil, Augumentin, Azelide) but TLC, DLC are still elevated. Please suggest what else we could do? Thank you...XXXX
Brief Answer:
if no complaints you might relax
Detailed Answer:
Hello sir ,welcome to healthcare magic.
I understand your concern.
In my opinion if there are no complaints like fever ,pain abdomen or tightness of abdomen,any backache and just elevated TLC and DLC they might not be significant.
Usually elevated TLC and DLC( increased neutrophils) are seen during pregnancy due to hormones like estrogen and cortisol .
And elevated levels with above said complaints might suggest infection.
Focus of infection is ruled out by doing all the necessary tests by your gynaecologist and physician.
Kindly get the peripheral smear evaluated by haematologist or pathologist to see for any abnormal forms of cells are seen.
If no abnormality found then it might be due to physiological rise only.
As there is no pain abdomen and CRP is normal even chorioamnionitis(amniotic fluid infection) is ruled out.
Kindly upload all the reports as I need to check them once and
I need to know :-
1)Does your wife have any complaints?
2)what for all the tests were done?
Regards....Dr.srilatha
if no complaints you might relax
Detailed Answer:
Hello sir ,welcome to healthcare magic.
I understand your concern.
In my opinion if there are no complaints like fever ,pain abdomen or tightness of abdomen,any backache and just elevated TLC and DLC they might not be significant.
Usually elevated TLC and DLC( increased neutrophils) are seen during pregnancy due to hormones like estrogen and cortisol .
And elevated levels with above said complaints might suggest infection.
Focus of infection is ruled out by doing all the necessary tests by your gynaecologist and physician.
Kindly get the peripheral smear evaluated by haematologist or pathologist to see for any abnormal forms of cells are seen.
If no abnormality found then it might be due to physiological rise only.
As there is no pain abdomen and CRP is normal even chorioamnionitis(amniotic fluid infection) is ruled out.
Kindly upload all the reports as I need to check them once and
I need to know :-
1)Does your wife have any complaints?
2)what for all the tests were done?
Regards....Dr.srilatha
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Dr Srilatha,
Thanks for your prompt response. I have uploaded couple of reports and will upload few more in the evening. We found high TLC and DLC during a routine checkup, we just wanted to know hemoglobin level. After that Gynec gave her Azelide, but it did not help. After 7-8 days we again had CBC and TLC & DLC were still elevated. So this time Gynec gave her Augumentin. After 4-5 days she had fever and vomiting, so we went to a physician. After the attached tests, phy gave her Cetil. Fever was gone after 2 days. But, TLC & DLC are still high. She does not have any other problem but she feels backache at night (it may be due to her disc bulging problem or gain in weight).
Mam, We also found on two sites that prolonged use of Heparin can cause elevated TLC & DLC. She is taking Heparin injection from 6th week.
http://www.buzzle.com/articles/white-blood-cell-count.html
http://buddymd.com/e/tests/result?y=7&Total_Leukocyte_Count=17400&c=2
Not sure how authentic these sites are. We will get peripheral smear evaluated soon. Kindly suggest if there is any harm to mother/baby due to elevated TLC & DLC considering that it is physiological rise only.
Thank You,
XXXX
Thanks for your prompt response. I have uploaded couple of reports and will upload few more in the evening. We found high TLC and DLC during a routine checkup, we just wanted to know hemoglobin level. After that Gynec gave her Azelide, but it did not help. After 7-8 days we again had CBC and TLC & DLC were still elevated. So this time Gynec gave her Augumentin. After 4-5 days she had fever and vomiting, so we went to a physician. After the attached tests, phy gave her Cetil. Fever was gone after 2 days. But, TLC & DLC are still high. She does not have any other problem but she feels backache at night (it may be due to her disc bulging problem or gain in weight).
Mam, We also found on two sites that prolonged use of Heparin can cause elevated TLC & DLC. She is taking Heparin injection from 6th week.
http://www.buzzle.com/articles/white-blood-cell-count.html
http://buddymd.com/e/tests/result?y=7&Total_Leukocyte_Count=17400&c=2
Not sure how authentic these sites are. We will get peripheral smear evaluated soon. Kindly suggest if there is any harm to mother/baby due to elevated TLC & DLC considering that it is physiological rise only.
Thank You,
XXXX
Brief Answer:
Physiological rise does not harm the mother or baby.
Detailed Answer:
Hello sir, I got your information.I have seen the reports.
All the reports are normal but for elevated TLC and DLC.
Heparin might cause elevated TLC and DLC by increasing the release of neutrophils from bone marrow.This is seen in 1% of cases.Iam providing this information as i read this in journals.
And physiological elevation is also seen in pregnancy due to estrogen and cortisol levels.
So all this are the reason for elevated TLC and DLC.
The backache might be due to spine problem or changed spinal curvature during pregnancy.
I suggest you to:-
1)Get the peripheral smear evaluated by haematologist or pathologist.
2)Get per vaginal examination done by your gynaecologist to see for any cervical changes due to any preterm labour.
Iam not diagnosing any condition but i feel it would be better if they are done .
Mostly this might be a physiological rise only.So relax its not going to harm mother or baby.
Best regards...dr.srilatha
Physiological rise does not harm the mother or baby.
Detailed Answer:
Hello sir, I got your information.I have seen the reports.
All the reports are normal but for elevated TLC and DLC.
Heparin might cause elevated TLC and DLC by increasing the release of neutrophils from bone marrow.This is seen in 1% of cases.Iam providing this information as i read this in journals.
And physiological elevation is also seen in pregnancy due to estrogen and cortisol levels.
So all this are the reason for elevated TLC and DLC.
The backache might be due to spine problem or changed spinal curvature during pregnancy.
I suggest you to:-
1)Get the peripheral smear evaluated by haematologist or pathologist.
2)Get per vaginal examination done by your gynaecologist to see for any cervical changes due to any preterm labour.
Iam not diagnosing any condition but i feel it would be better if they are done .
Mostly this might be a physiological rise only.So relax its not going to harm mother or baby.
Best regards...dr.srilatha
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Dr Srilatha,
We had peripheral smear done. Physician was on vacation so it took some time. He asked for ESR, CRP and smear along with whole abdomen ultra sound plus X - ray. We are concerned about X Ray but he says it can be done using a lead shield. We have done blood tests only till now. ESR and CRP are within range. But, peripheral smear has below:
WBC series show a neutrophilia.
Neutrophils show toxic granules.
No immature or abnormal cells seen.
Conclusion: * NORMO-MICROCYTIC HYPOCHROMIC ANAEMIA WITH NEUTROPHILIC LEUCOCYTOSIS
As we raised concerned regarding X Ray, he said at least get ultrasound done and have prescribed Cefditran 200 and Celex-od 500 for ten days. We want to avoid antibiotics at this moment. Kindly review the latest report (Smear.pdf) and please suggest what needs to be done. As no immature or abnormal cells are seen in blood smear so shall we consider it as philological change or we shall go for antibiotics and ultrasound and X Ray? Also what is he trying to find from ultrasound and X ray.
Thanks
XXXX
We had peripheral smear done. Physician was on vacation so it took some time. He asked for ESR, CRP and smear along with whole abdomen ultra sound plus X - ray. We are concerned about X Ray but he says it can be done using a lead shield. We have done blood tests only till now. ESR and CRP are within range. But, peripheral smear has below:
WBC series show a neutrophilia.
Neutrophils show toxic granules.
No immature or abnormal cells seen.
Conclusion: * NORMO-MICROCYTIC HYPOCHROMIC ANAEMIA WITH NEUTROPHILIC LEUCOCYTOSIS
As we raised concerned regarding X Ray, he said at least get ultrasound done and have prescribed Cefditran 200 and Celex-od 500 for ten days. We want to avoid antibiotics at this moment. Kindly review the latest report (Smear.pdf) and please suggest what needs to be done. As no immature or abnormal cells are seen in blood smear so shall we consider it as philological change or we shall go for antibiotics and ultrasound and X Ray? Also what is he trying to find from ultrasound and X ray.
Thanks
XXXX
Brief Answer:
It might be a physiological change
Detailed Answer:
Dear sir,
Glad to hear from you again. I understand your concern.
In my opinion the neutrophilic leucocytosis might be a physiological change only.
I saw the reports and all are normal but for elevated counts. The peripheral smear is normal without any abnormal forms. So you need not worry. And also you have no complaints like fever, pain abdomen or any signs of infection anywhere so you might not need any xray or ultrasound and antibiotics.
Doctor might be in a suspicion of any infective focii, so he asked for investigations. But in my opinion any infection if present will show up fever and other signs.
As your wife has no complaints you can be relaxed. Do not worry.
Hope this satisfies your query.
Feel free to ask any more queries.
Good luck....Dr srilatha
It might be a physiological change
Detailed Answer:
Dear sir,
Glad to hear from you again. I understand your concern.
In my opinion the neutrophilic leucocytosis might be a physiological change only.
I saw the reports and all are normal but for elevated counts. The peripheral smear is normal without any abnormal forms. So you need not worry. And also you have no complaints like fever, pain abdomen or any signs of infection anywhere so you might not need any xray or ultrasound and antibiotics.
Doctor might be in a suspicion of any infective focii, so he asked for investigations. But in my opinion any infection if present will show up fever and other signs.
As your wife has no complaints you can be relaxed. Do not worry.
Hope this satisfies your query.
Feel free to ask any more queries.
Good luck....Dr srilatha
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you Dr Srilatha for your response. I am feeling relaxed. So, ESR value (64) is normal? At present TLC count (present 18,800) has increasing trend. When shall we consider it alarming? We have planned CRP, CBC, Doppler, Urine Routine in next 3 weeks. Shall we consider anything else?
Thank you
XXXX
Thank you
XXXX
Brief Answer:
ESR up to 40/hr is normal
Detailed Answer:
Hello sir,
I got your query.
In my opinion the neutrophilic leucocytosis upto 20000/mm3 can be considered normal in pregnancy. So you need not worry about that. And go on with your investigations.
E.S.R up to 40 mm/ hr is considered normal in pregnancy.
Increased E.S.R might be seen in:-
1) Thyroid abnormalities or hypothyroidism.
2) Rheumatoid arthritis - Here there will be joint pains. A factor will be positive here.
So you can rule out the above conditions by doing thyroid profile for thyroid abnormalities and RA factor for Rheumatoid Arthritis.
If you don’t have symptoms of joint pains or any other complaints you might not worry about elevated ESR because only 60% of patients with elevated ESR have symptoms.
But better to rule out the above said conditions. If those tests are already done and they are normal you might be relaxed.
Hope this satisfies your query.
Feel free to ask any more queries.
Good luck...Dr.srilatha
ESR up to 40/hr is normal
Detailed Answer:
Hello sir,
I got your query.
In my opinion the neutrophilic leucocytosis upto 20000/mm3 can be considered normal in pregnancy. So you need not worry about that. And go on with your investigations.
E.S.R up to 40 mm/ hr is considered normal in pregnancy.
Increased E.S.R might be seen in:-
1) Thyroid abnormalities or hypothyroidism.
2) Rheumatoid arthritis - Here there will be joint pains. A factor will be positive here.
So you can rule out the above conditions by doing thyroid profile for thyroid abnormalities and RA factor for Rheumatoid Arthritis.
If you don’t have symptoms of joint pains or any other complaints you might not worry about elevated ESR because only 60% of patients with elevated ESR have symptoms.
But better to rule out the above said conditions. If those tests are already done and they are normal you might be relaxed.
Hope this satisfies your query.
Feel free to ask any more queries.
Good luck...Dr.srilatha
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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