A 24-year-old man came to the emergency depament with a broken leg. A blood test revealed his WBC count to be 22 x 103/ml. Five hours later, a second blood test revealed values of 7 x 103/ml. What is the cause of the increased WBC count in the first test?
**Core Concept**
The increase in white blood cell (WBC) count in response to tissue injury, such as a broken leg, is a classic example of acute inflammation and the body's immune response. This phenomenon is mediated by the release of various cytokines and chemokines that stimulate the bone marrow to produce more WBCs.
**Why the Correct Answer is Right**
The increased WBC count in the first test is primarily due to the release of histamine and other vasoactive amines from damaged endothelial cells and mast cells. These mediators cause the blood vessels to become permeable, allowing the WBCs to migrate out of the circulation and into the site of injury. Additionally, the release of cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) stimulates the bone marrow to produce more WBCs, particularly neutrophils, which are the primary cells involved in the acute inflammatory response.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because there is no direct evidence to suggest that the patient has a bacterial infection that would cause a sustained increase in WBC count. The patient's condition is acute trauma, not a chronic infection.
**Option B:** This option is incorrect because acute stress response, such as that caused by trauma, can lead to an increase in WBC count due to the release of cortisol and other glucocorticoids. However, this response is typically short-lived and would not cause a sustained increase in WBC count.
**Option C:** This option is incorrect because the patient's WBC count decreased significantly over the course of five hours, which is not consistent with a chronic infection or autoimmune disorder.
**Option D:** This option is incorrect because there is no evidence to suggest that the patient has a hematological malignancy that would cause an abnormal increase in WBC count.
**Clinical Pearl / High-Yield Fact**
In cases of acute trauma or inflammation, the WBC count can increase significantly due to the release of cytokines and chemokines that stimulate the bone marrow to produce more WBCs. This response is typically short-lived and resolves once the underlying cause of the inflammation is addressed.
**Correct Answer:** C.