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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    I'm voting to close this question as off-topic because it asks for a medical advice for an actual person who seems to be in the life-threatening situation in the ER. There is very little chance that anyone, including the OP, the related person or the readers will have any benefit from any answer, because there is no authority here to validate the correctness of an answer. Who will take responsibility if anything goes wrong? – Jan Dec 7 '18 at 8:03
  • @Jan It does not ask for medical advice. – Carey Gregory Dec 7 '18 at 15:51
  • I can't imagine from what other reason is this question asked then. I have never had a stronger feeling that someone would actually do some personal action on the basis of an answer. It's like an ad hoc online consilium trying to solve the actual case. – Jan Dec 7 '18 at 15:56
  • @Jan The patient is in CCU and I'm pretty sure OP isn't a CCU doctor asking for advice. Look at the last paragraph. The questions ask for a possible explanation, not advice on what to do about it. I very much doubt that any answers given here will affect treatment decisions. – Carey Gregory Dec 7 '18 at 16:03
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    It's a son asking for an explanation of the potentially life-threatening condition of his mother. It's this context. I can't see how anyone could make an useful general answer to such a specific question. – Jan Dec 7 '18 at 16:04

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