Thanks to your reply. of course body exercise effects on laboratory results in a several events.my question is about a given population whose WBC count is always be higher than other populations but it is taken account as a specific disorder.in the other the body of them is compatible and no sign of problem can be observed.

I hope i could clarify my statement .

regards

Firstly, I will like to apologize for not being able to provide a simple answer to your question. Perhaps your interest on elevated white cell count (leucocytosis) could be improved by asking a more finite target. Most likely I presume you are refering to high neutrophil counts (neutrophilia). However high white cell count could also be contributed by elevated lymphocyte count (lymphocytosis). Some people with asthma or occult worm infestation has persistently elevated eosinophil counts which lead to high white cell count.

Your later statement in the second posting 'is compatible and no sign of problem can be observed' is difficult to model mathematically. Many pathological disorders are subclinical at its early phase of disease. It's presentation could not fit into any particular clinical pattern hence unclassifiable. We often just follow them up to detect any progression or new clinical development. For example, a couple of years back, a young gentleman in his 20's presented just with elevated white cell, neutrophilia to be precise with all stages of maturation present. He has no other clinical signs. The only other issue that was not pleasing was elevated basophils as well. His peripheral blood was tested positive for bcr-abl translocation by nested pcr. That led to other tests and eventually a diagnosis of chronic myeloid leukaemia was made. If we had seen such a case in the 20th century, we will probably just follow him up until his spleen becomes palpable. Sometimes when the values remained unchanged for years, we may labelled it physiological but there is still caution in the air.

Having brought the above issues into perspective, I will then address leucocytosis which is mostly due to excessive white cell proliferation either as polyclonal or monoclonal proliferation.

The former is due to excessive physiological stimuli. Any condition which drives up serum cortisol or adrenaline level will drive up neutrophil production. Any event that drives up G-CSF will obviously push up white cell production. Hence anyone with stress be it physical (i.e any infection/inflammation, a week scaling the Himalayas, pregnancy) or psychological (emotional stress) are bound to have leucocytosis. It is common to see leucocytosis in the coronary care unit among patients admitted for myocardial infarction. I suppose going by your first posting, this will be your area of interest.

The latter which is monoclonal proliferation resulting from some form of myeloproliferative (MPD) or lymphoproliferative disorders. The earlier example, CML can be pathophysiologically considered a form of myeloprolifative disorder but by nomenclature the experts has segregate it into a corner. Nowadays our ability to identify MPD patients had improved. By doing pcr for jak2 mutation we are able to identify these patients early. Please note that such patients may not harbours any clinical signs of physical illness. They may just have non-specific lethargy which was overlooked by eveyone. It only became an interest after a blood count. Why are we interested with this population. The elevated risk of venous thrombosis.

Similarly there are a considerable number of elderly person with elevated lymphocytes and may have chronic lymphocytic leukaemia. Why aren't the health system seeking them out? Why should we? They are probably in stage RAI 0, which do not warrant any treatment anyway. (There are those who think otherwise). Not cost effective.

SO EVEN SOMEONE WITH A DISEASE MAY BE THOUGHT TO HAVE A 'PHYSIOLOGICAL ABNORMALITY' IF HIS OR HER CONDITION IS NOT TAKEN SERIOUSLY ESPECIALLY WHEN THE DISEASE IS STILL EARLY.

Anyone who has an elevated high cell count has a reason for having them. The bottom line, is how exhaustive do we wish to investigate. Take this one for example. We happen to find several siblings to a person who has elevated leucocyte also have similar situations. It runs in the family! Otherwise they are all well. Someone investigated them and found a mutation in the granulocyte-colony stimulating factor receptor, switching it perpertually on and hence continous white cell production. See reference: jem.rupress.org/content/206/8/1701.full.pdf By the way whom among us has the luxury to perform this genetic study?

Last but not least population based normal values differs between population. Several colleagues of mine published the hematological reference values consisting of Kelantanese population. T M Roshan, H Rosline, S A Ahmed, M Rapiaah, A Wan Zaidah, M N Khattak (2008) Hematological reference values of healthy Malaysian population. Int J Lab Hematol. May 21.

http://onlinelibrary.wiley.com/doi/10.1111/j.1751-553X.2008.01068.x/abstract

Dear Ahed. My apology. I was not explicit but mentioned it in passing. I don't suppose anyone may consider the physical changes experienced by a pregnant mother as non-physiological.

Thanks to your great answer my colleagues,

there is an example, people who live in mountain have a high level of haemoglobin but this event is not categorised as a pv, while in some situation the amount of hb and hct in those people are as same as person who are pv or smoking.therefore,when the people are visited by gp,the gp does not follow-up them or put a treatment.

I hope i could clarify my statement

Dear Reza,

I am not sure if I have understood your last posting correctly. Elevated hemoglobin and white cell are two different thing. Chronic hypoxia (in high altitude) continuously push EPO level which drives the hemoglobin level. Hence they get polycythaemia. This is physiological and not PV which is clonal proliferation (part of MPD). On the other hand the early luecocytosis upon shifting oneself to a high altitude is only temporary and they return to normal as part of acclimatization (if the individual continues to stay in that environment for say two weeks). Here is a paper to highlight this. http://www.clinsci.org/cs/111/0163/1110163.pdf

Or maybe your last posting was just to provide an anology in the red cell situation, something similar to what you are seeking for in the white cell series. Then I rest my case.

By the way, the pleasure was mine, to get this rusty mind of mine back strolling a bit.

Of course i know that wbc and rbc are two different things i just wanted to exemplify , so your second point is correct.

Go ahead i think we can fin my answer together

regards

normal ranges are based on 95% confidence interval, which i think means 5% of the population will be outside the normal range, 2.5% above (us) and 2.5% below.

obesity is recognized as a possible cause for reactive leukocytosis.

Relative to white people, black people have a lower total WBC count.In contrast, Mexican Americans have been shown to have a higher leukocyte count.

In a person with sickle cell disease, the baseline WBC count is elevated with a mean of 12-15 X 109/L (12-15 X 103/µL).lung diseases such as pneumonia and tuberculosis,leukocytosis is usually present.rheumatoid arthritis,some neurological condition like sieizure leucocytosis is present.Infants with Down syndrome frequently have leukocytosis.Patients of systemic lupus erythematosus,ulcerative colitis, and inflammatory bowel diseasehave leucocytosis.In polycythemia vera (PV) overproduction of leukocytes and platelets is occur.

if you clearly defined your reason to know about the leucocytosis in different populalation then may be we all help you more.

http://[email protected]

Thank yo to reply.

Would you mind if you send a few articles or introduce their references

regards

Cigarette-smokers are well known to have a higher WBC and N counts