I am concerned about both of these patients whose problems are completely opposite. One patient has too many white blood cells (WBCs), the other does not have enough. The normal range of WBCs is 4000-10,000. One patient has 50,000 and the other has 600. Both came in through the emergency room where I was working on Monday.
The one with low WBC count has the risk of serious infection, and in fact she does have pneumonia. The problem is her body cannot mount an immune response to fight the disease. So we treat as strongly as we are able with antibiotics and hope and pray. Her low WBC count is probably caused by her long history of lupus and the immunosuppressive drugs that she has been taking for years.
I suspect this young man has leukemia. He came in with a very high white blood cell count and an unusual skin rash that I think is an unusual leukemia presentation. He then quickly demonstrated that he has pneumonia or lung involvement as well on a chest x-ray. Hopefully we can get him seen by a hematologist or oncologist so that he can be treated successfully against this cancer.