Brief Answer:
Cough, Allergies and Lymphocytes

Detailed Answer:
Hi XXXXXXX Thanks for coming to HealthCareMagic. I see that you have been suffering from a chronic (I am assuming low level) cough that worsens at night for about 1 month.

I am glad you got the WBC count and differential count done and uploaded it here, it is illuminating.

Lets start by understanding these blood test results and then move on to forming a plan for the management of your cough.

The WBC count (7200) is the total count of White Blood Cells seen in 1 cubic millimeter of blood drawn. 7200 is actually normal. Most people have a count of between 4000 and 12000 under normal circumstances and this is nothing to worry about. If the counts are elevated (above 12k), that is interpreted under most circumstances as being a sign of an infection in the body. The infection could be viral, bacterial, parasitic or fungal in nature.

Trying to divine the nature of the infection is what the differential count is useful for. POLYmorphoneucleosites are also known as Neutrophils. They are a type of White Blood Cell that you can compare to a foot soldier. They attack EVERY type of infection, but they specialize in Bacterial infections. If those numbers are high.. it's interpreted as a sign that the infection is bacterial.

LYMPHOcytes on the other hand are highly specialized cells that are very good at making chemicals called Antibodies. These antibodies are good for many things, but are best at killing and deactivating VIRAL infection. They also have a tendency to get overative in allergic conditions.

An Allergy is basically a situation where your immune system is responding to a harmless external irritant (dust, pollen, smoke, etc) like an infection. It's a mistake on the part of the immune system.

In your case, your Total WBC count is normal but your Lymphocytes are slightly elevated. In that case, coupled with your cough, I would assume that you are having an allergic reaction to something that you have breathed in. Dust , pollen , some fabrics, cat hair, dog hair etc can all cause this reaction.

So the first thing you need to do is look at your environment. Has anything changed? Have you started using a new type of bedding? Have your Airconditioner filters been cleaned recently? Has new construction started next to your home raising lots of dust? I'm just trying to give examples of situations where you might be exposed to a new Allergen in the air for you to breath in. Your best course of action is to try and eliminate this allergen if possible.

The next thing is to consider anti allergy medications. There are many that can be used to calm the cough down. Antihistamine medications like Cetrizine, Montelukast, Fexofenadine etc are very good at dealing with these kind of situations. Nebulizations (medications that are aerosolized and breathed in through an inhaler) like Duolin and Budecort are immediately effective.

But these drugs are NOT AT ALL good for use against a real infection (bacterial or viral) as they are basically interfering with the immune systems work.

So before you start an antihistamine, you need to be VERY sure that there is no real infection or at least the real infection is being dealt with properly (antibiotics, etc).

I would suggest the following plan of action. Your Blood test is a useful fist step here, the next steps are

1) Check your temperature with a thermometer 3 times a day and write down the results. If you have a fever, then that is a sign that this is NOT an allergy, rather its an infection and needs antibiotic meds.

2) Get a Chest X-ray, to look at the lung. If you have any signs of pneumonia (an infection) then you will need antibiotics.

Once these test are done and they are negative. Then you can start on a course of inhaled (nebulized) antihistamines. You can invest in a home nebulizer and load it with Duolin and Budecort twice a day for a week. This would be the most effective and have the LEAST side effects. After one week, you can re-evaluate the cough and see if you need to continue at all. If you do, you could add oral antihistamines (like Cetrizine) to the mix.

Did that make sense? I hope I have begun to address your concerns. Feel free to follow-up.

Vinay

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