I am 34 weeks pregnant.  Five weeks ago, my OB/GYN ordered a routine
CBC which showed an elevated white blood cell count. They were not
concerned, and told me they would recheck in a month at my next visit.
 It was checked again last week and the office called to say it was
unchanged at 13.3.  My doctor told me that it is sometimes elevated
during pregnancy and not to worry about Leukemia.  I wasn't worried
about Leukemia until she mentioned it!  I also have a rash starting at
the right side of my left hand and and running all the way up the
right side of the arm to the shoulder.  The rash appeared about 2
months ago, it does not itch, and it is not going away.  I've read
about Leukemia a bit online and I'm concerned my rash resembles
petachie (I think that's how it's spelled).  I also have ulcerative
colitis, but I'm not in an active state currently.  When I started my
pregnancy I was in an active state and I was taking 10 asacaol a day. 
I have stopped taking the asacol about 2 months ago since I was no
longer having symptoms and I was concerned about taking that amount of
medication pregnant.

I'd really like to know what could be causing my elevated WBC -- could
it be Leukemia or possibly due to my UC even though its not in an
active state right now?  I'm just sick with worry so any information
is greatly appreciated!

Thanks,
Michelle

Hi Michelle!

You must be a first timer.  Congratulations!  Buckle your seatbelt and
hang on tight - motherhood is one of the wildest roller-coaster rides
ever.  I've been at it myself for 11 years (two boys, ages 7 and 11),
and I'm still amazed every day at how much I can learn from my darling
Monsters.

At 34 weeks, you're almost finished!  Hooray! 

Now...that white blood cell count...

A slightly elevated WBC count is not at all unusual during pregnancy:

"Member: Would a high white blood cell count cause problems with
pregnancy? What causes it?

Grunebaum: A high white count can be normal because of the pregnancy.
And it depends how high it is. With an infection there is often an
elevated white count. In and by itself it doesn't necessarily mean
much unless you find out why it's elevated and how much it's
elevated."

WebMD Chat with Amos Grunebaum, MD.
http://webmd.lycos.com/content/article/62/71808.htm


It's probably nothing at all, and I can't imagine why your doctor
would have mentioned leukemia!  Everyone knows that new moms worry
about EVERYTHING!  (Clearly, your OB forgot this.)

Reasonable things it could be:

-- bladder infection
-- urinary tract infection
-- other simple infection (like an ingrown toe-nail or an infected
cut)

Any of these is enough to slightly increase your WBC count, and of
them, the most common affliction during pregnancy is the urinary tract
or bladder infection:

"Technicians also check the urine for an elevated white blood cell
count, which could signal disease or infection of the kidney or
bladder.

[...]

Infection - An elevated white-blood cell count indicates that a woman
has an infection in her body."

What Can I Expect At The Doctor's Office?
http://health.yahoo.com/health/centers/pregnancy/502.html

According to medical resource site MedLine, physical or emotional
stress can also contribute to a high WBC count:

"Acute emotional or physical stress can increase WBC counts."

MedlinePlus - WBC Counts
http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm

What could be more physically or emotionally stressful than being
pregnant in the middle of one of the hottest, most uncomfortable
summers in recent memory?

If your doctor isn't worried about your WBC levels, you probably
shouldn't worry either.  Obviously, she's keeping an eye on things,
else she wouldn't have done another blood test.  Relax, have yourself
a deep breath, and drink lots of fluids to help fend off UTIs and
similar unpleasantness. (The more you pee, the harder it is for
bacteria to cling to your urinary tract and cause infections.)

Non-itchy rashes are similarly common in pregnancy, and typically
nothing to worry about.  These are caused by the hormone fluctuations
of pregnancy, which also affect your skin:

"Rash

What is it? In pregnancy, the increased blood flow makes you feel much
warmer than before and also causes you to perspire more. This may
result in red rashes. It is also seen to be associated with being
overweight in pregnancy."

Nine Months : Common concerns and discomforts
http://www.mothersbliss.co.uk/nine/concerns/probr.asp

There are a few sites available discussing rashes and skin conditions
occurring during pregnancy:

Skin rashes in pregnancy
http://www.netdoctor.co.uk/womenshealth/facts/skinrash_pregnancy.htm

Skin Rash in Pregnancy
http://www.babymed.com/docs/english/596.asp

rash in pregnancy
http://www.gpnotebook.co.uk/cache/255131715.htm

Again, if your doctor isn't concerned, you probably shouldn't be
either.  These are just common "side effects" of pregnancy, and not a
major cause for concern.

Good luck, Michelle!  May your labor be short and may your baby be a
good sleeper!

--Missy

Search terms: [ elevated white blood cell count pregnancy ], [ rash
pregnancy ], and two pregnancies.

Dear Svetliski-ga. I`m not a G.P. but I do have the blood disorder
known as C.L.L. Having done a lot of research into the subject, i
would like to assure you that IF you have anything, it can be beaten.
Don`t take any one doctors opinion on your health and that of your new
baby. If the 13.3 you refer to is a WBC of 13,300, it is too high. I
was diagnosed at 9,000, which went to 93,000 and with just three
months treatment, is heading back to below 32,000. I`m still waiting
on results this month. The more research you do on the subject, the
easier your mind will be. Ignorance is not bliss. I`ll mention you in
my prayers.

Hi Svet,
     A WBC of 13.3 represents a slightly elevated white count. It
generally reflects the presence of some inflammatory or infectious
process. A leukocytosis (WBC elevation) of this magnitude is often
seen both in the presence of pregnancy and in its absence. Of
importance in assessing it further is a 'differential' which is
nothing more than a breakdown of the types of white cells present 
by percentage. This is done automatically when the WBC is elevated.
     The most likely situation, assuming you don't have some
localized problem like an abscessed tooth, is that there is some
activity in your Ulcerative Colitis. I also assume that you are not
leaking amniotic fluid. Leukemia in the absence of the presence of
bizarre cells in your peripheral blood smear is very unlikely. 
     You mention that you have a rash which could represent petechiae,
small hemorrhages into the skin. When your WBC was assessed so was
your
platelet count. This count, by the way, rises in pregnancy. If it is
normal, forget about petechiae.
     If  you were my patient and had a normal platelet count and a
differential that was not extremely abnormal, I would simply follow
the situation.I think that the likelihood of a serious problem is
exceedingly small.
    Good Luck!

Thank you everyone who responded it was very helpful.  I have a
question for Raisondetre-ga, You mentioned if I were your patient you
would just follow the situation as my OB said she would, so I'm
wondering if you are a physician?  Do you think my OB would have
mentioned if there was a problem in the differential, and would
abnormal cells be picked up as part of the routine CBC, or would they
only look for that after there was an elevated WBC -- on an additional
or more in-depth test?  I also assume they would have mentioned if my
platelet level was abnormal, so your comment about the petachie is
very reassuring.  I guess I should call their office to clarify
whether everything else was normal (differential and platelets).  I
really appreciate the time you took to answer my questions.  I'm
beginning to feel more relieved.  I was just concerned because I have
not been sick at all and the counts haven't changed in a month.  Thank
you for your input and help.
Michelle

Hello Again,

     I am a licensed physician.

     When a routine CBC (complete blood count) is ordered,
generally a purple topped tube of blood (contains the
anticoagulant EDTA) is submitted to the laboratory. A
technician puts a small amount of this blood into a machine 
which automatically analyzes the sample and prints out
values for WBC (white cell count), RBC (red cell count),
HGb (hemoglobin level) as well as the platelet count.
To proceed with a differential involves considerably more
work since the process is usually not automated. Usually,
a slide is made from the sample, suitably stained and examined
by a technician under a microscope. He counts and categorizes
100 white blood cells by type (for example poly, lymphocyte,
monocyte etc.). Because this procedure is not cost effective
in the presence of a normal WBC, or, really, an almost normal
WBC, different labs have different standards as to what cut off
levels to use in deciding whether to do a differential. If a 
differential is done, any technician qualified to do it
must be able to immediately recognize an abnormal cell
which does not belong in peripheral blood in the absence
of severe hematologic pathology.
   
     I have learned, in medicine as in life in general, it is
safer not to make assumptions about what another person will
or will not do in a given set of circumstances unless one
has knowledge based on extensive personal experience with
that person. I would, therefore, recommend that you do not
assume but rather ask.

     I wish you Good Health and the Best of Luck!