Ramblings of an Emergency Physician in Texas
Count me a sceptic: Kevin MD is on the same track.
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Allen, i am not surprised in the least about the reliance on a white cell count as the marker for such a complex disease state as CAD..i dont know about your consultants, but most of mine are permanently prostated at the altar of the CBC-you can barely get two words about a pt in the ED before the inevitable “is the wbc ok?”
Just yesterday, an oncologist sent his pt (on chemo)to the ed for a cbc because she was having fever to 101 with a clear cut uri -cbc was normal so he decided to not come and see the pt and told the nurse to ‘have the er doc medically screen her’….i saw the pt and asked him, what if the cbc showed a wbc of 15k would you keep her or culture her up etc? he said no, I would have sent her home because she has uri-and then I was like-so…..no matter what the cbc you would have sent her home? after that the conversation understandably deteriorated ;)
I would love to discuss this study with a certain dr utecht-oh and I posted the previous comment also-forgot to enter my name..
I thought of exactly the same residency instructor, the one who’d ask you “why do you want to order a CBC?”. He was right then, and right now.
I still mostly order them for the consultant. Utecht rules the CBC.
(For those to whom this is Greek: it’s a Fresno EM residency thing, sorry).
I lost my naive faith in WBC’s during physiology class. We did several WBC’s on classmates before & after they ran up and down a flight of stairs. All counts doubled as would be expected from demarginalization.
It would be wonderful if family physicians would chill out about the relevance of the WBC. I’am a patient that has experienced 5 years of scares and frieght over an elevated WBC. I have been sent to 3 cancer Drs. because my PCP will not except the fact that my WBC is elevated and we have no clue why it is that way. Initially it was in the 13,000 to 14,000 range back in 2000-2003. For the last year it has elevated a little more to the 16-18,000 range. I am not sick, except when my PCP orders a CBC and then he panics and makes another appointment with another cancer Dr. or hemotalogist or whoever. I get so scared then that I start to imagine all sorts of symptoms, even getting so nervous I break out in rashes. I think way to much attention is placed on WBC.
The above URL is a link to a 5 year study of 1900 patients with normal WBC and appendicitis ranging from accute to peritonitis. I, could be considered in the 11% (actually 7%) of patients with perforated appendicitis, fever, major pain, all the symptoms, but normal WBC. I was 49 years old – healthy female peri-menopausal of slight build.I was eventually treated with an emergency appendectomy and a 5 day hospital stay. My family physician checked me over thoroughly and did believe it was the appendix, but didn’t refer me to a surgeon for 8 days because my initial wbc was normal. To quote, he said ‘ no self-respecting surgeon would consider you with a normal WBC– we need to look at other causes’. He instead , sent me for an ultrasound to look for an ovarian cyst (none found). I did some research after my recovery and found the article in the link above. I hope the physicians reading your website will find it of interest.
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