Consistently high WBC, normal CRP in a post-cardiac arrest patient
A patient had an elective coronary angioplasty which showed 80% blocked LAD. A stent was placed. She was stable and sent home. The next day she felt unwell and collapsed with LOC for a few seconds. She was taken back to hospital and was admitted to CCU for observation. She had sinus bradycardia around 40. That night she was bradycardic and went into bradycardia-induced VT leading to VF and full arrest. Fortunately, she was resuscitated and a temporary pacemaker (TPM) was inserted. They planned to insert a permanent pacemaker (PPM) within the next few days; however, her WBC count was 20 000, predominantly neutrophils. CRP was 19. Her baseline before angioplasty was within normal range. It's been 3 weeks since then, multiple blood and urine cultures have been negative, no fever, she seems to be improving physically. She has been on a multitude of antibiotics including piptaz + amoxicillin and now vancomycin. Each antibiotic initially reduced WBC count to a few figures but back up the next day. At the moment its hovering at 16K.
The initial TPM was removed and replaced with another a week ago in hope that it was likely TPM lead infection.
Why would she have a raised WBC count with no other suggestion of infection? Do post arrest patients have a high WBC count due to reperfusion injury? Or could it be a reaction to foreign body?
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