<s>[INST] What possible conditions can be related to an increase WBC, Increase Neutrophil Count, Positive Ra, Positive ANA, Decreased RBC, Decreased Erythrocytes, Decreased HCT. Lyme Tests negative, Double Stranded Lupus Test Negative. Patient initially presented with swelling in bilateral ankles increasing up legs with redness, hand stiff and painful to bend, also some fatigue and inability to lose weight despite diet and exercise. This is a family member and we need advice as to what type of physician needs to be consulted. She will be getting a referral to a Rheumatologist. [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Elevated WBC can occur in most of conditions like infections, leukamoid reaction and blood disorders like leukemia. You hadn't mention how much WBC are in your family member? If it is between 30000-50000, then it is most likely leukamoid reaction and which can fit with the rest of your investigations report. positive ANA and RA indicates that the patient is suffering from autoimmune or rheumatological disease. Negative double stranded DNA rules out Systemic Lupus. The rest goes in favor of rheumatoid arthritis or scleroderma. If there is small joints swelling and stiffness in morning then it is most likely rheumatoid arthritis. If hands are stiff and shiny and also the patient has other symptoms like difficulty in swallowing then it will fit scleroderma. So you will need to consult a rheumatologist for these. Hope I have answered your query. Let me know if I can assist you further. </s>