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Hematologic Diseases
Question #22215
48 days ago
124

Why wbc are higher everytime are they normal - #22215

Bisma

My wbc wheneverI test CBC everytinme wbc are 11k 9k 14k like that esr 42 is this due to stress Hello Doctor, I am an 18-year-old female seeking guidance regarding ongoing symptoms for the past 2 months. My main concern is heart palpitations and high heart rate. I have recorded a maximum HR of 150 bpm on ECG, around 110 bpm during doctor visits, and 90–100 bpm at rest normally. I have undergone 4 ECGs, all showing sinus tachycardia. I have been evaluated by two cardiologists. My echocardiography is normal, and no structural heart disease was found. Along with this, I experience full body aches, mainly in the neck, shoulders, arms, calves, and sometimes joint discomfort. I also have tingling sensations, cold hands and feet, and occasional numbness, especially with sitting or activity. Sometimes I feel a lump/tightness in the throat, with a sensation of difficulty breathing, though oxygen levels are normal. Relevant history: Had dengue fever 3 months ago These symptoms started about 2 months ago and persist Investigations done: Echocardiography: Normal Abdomen & pelvis ultrasound: Normal TSH: 1.28 CBC: WBC 11,000; Hb 13.1; RBC 5.1; Platelets 371,000 CRP: 11 ESR: 42 Vitamin D: 36 Ferritin: 46 Vitamin B12: 198 Cholesterol: 166 Evening cortisol: 10 hbA1c 5.1 Random blood sugar 101 I would like your opinion on: Whether these symptoms could be due to circulation issues, autonomic dysfunction (e.g., IST/POTS-like), post-viral effects, or anxiety-related causes Whether any further tests are needed Whether treatment or lifestyle measures should be started at this stage Thank you for your time and guidance. Kind regards, [Your bisma]

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Doctors' responses

Dr. Shayeque Reza
I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.
48 days ago
5

Based on your history, symptoms, and investigations, the findings most strongly suggest a post-viral autonomic dysfunction with anxiety overlay, rather than a dangerous heart, blood, or circulation disorder.

Your repeated sinus tachycardia with a normal echocardiogram and ECGs rules out structural heart disease. A resting heart rate of 90–100 bpm with spikes during stress, illness, or medical visits is commonly seen in Inappropriate Sinus Tachycardia (IST) or post-viral dysautonomia, especially after infections like dengue fever, which is known to trigger prolonged nervous-system symptoms.

Your persistently mildly elevated WBC (9k–14k) along with high ESR (42) and CRP (11) indicates ongoing low-grade inflammation, which can persist for months after viral infections. Stress and anxiety can cause mild WBC elevation, but ESR and CRP elevation point more toward a post-infectious inflammatory state, not something dangerous like cancer or severe infection.

The body aches, tingling, cold extremities, throat tightness, palpitations, dizziness, and breathlessness with normal oxygen levels are classic symptoms of autonomic nervous system imbalance, often worsened by anxiety and hypervigilance. Your low-normal vitamin B12 (198) may also contribute to tingling and nerve-related sensations.

There is no evidence of circulation blockage, heart failure, thyroid disease, diabetes, or hormonal disorder based on your tests. What this means

Most consistent diagnosis: Post-dengue autonomic dysfunction (IST/POTS-like) + anxiety Not life-threatening Common in young females after viral illness Recovery is gradual but expected

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Given the range of symptoms you’re experiencing and your recent medical history, several factors could contribute to your abnormal lab values and health complaints. Elevated WBC counts like yours—ranging from 9k to 14k—can be due to various causes including stress, infections, inflammation, or more rare conditions. Your recent history of dengue fever, alongside persistent elevated WBC and ESR (which indicates inflammation), suggests continued immune response or post-viral effects could be at play here. The symptoms of palpitations, high heart rate, and body aches can indeed be related to autonomic dysfunctions; conditions such as Inappropriate Sinus Tachycardia (IST) or Postural Orthostatic Tachycardia Syndrome (POTS) might be worthwhile to explore.

While your cardiac evaluation appears normal, the tachycardia and accompanying symptoms suggest that an autonomic nervous system issue or post-viral syndrome might be considered. Anxiety could amplify some of these symptoms, but it’s crucial to rule out physiological causes initially. Your Vitamin B12 is on the low end; a deficiency might contribute to neurological symptoms like tingling and numbness. Supplementing B12 might be a beneficial step. Monitoring thyroid function is important, but TSH levels seem normal, ruling out thyroid dysfunction. Considering an assessment for POTS is advisable, which might involve a tilt table test and heart rate variability studies.

Given the complexity of symptoms, it’s recommended to integrate lifestyle measures such as adequate hydration, increased salt intake, and gentle exercise appropriate for your ability, such as yoga or swimming, to stabilize heart rate and improve circulation. Consulting a neurologist or an autonomic dysfunction specialist can provide more specific guidance on managing your condition. Be mindful if symptoms worsen or new ones like chest pain or severe breathlessness arise, necessitating immediate medical attention. Continuous follow-ups with your healthcare provider will be essential to monitor symptom progression and adjust your care plan accordingly.

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