### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
For the last year I have been having WBC with diff done every 3 months due to a high WBC of 19,000. This count has fluctuated throughout the year, but never been normal, also no illness to account for. I do have symptoms of fatigue, petechiae (hands, arms, and chest-occasionally), HTN, and some diarrhea. EKG from 5 years ago normal, LFT normal, CMP normal, Rheumatoid normal, kidneys normal. Been to an allergist and told I do have even more allergies, but would not account for the high WBC. Sed rate slightly elevated. Please advise. Jen

### output:

Hi and thanks for the question, Chronic elevation of the ABCs deserves a more critical evaluation. In your case especially, the association with increased ESR, fatigue and petechial suggest exclusion of a bone marrow malignancy, especially a leukemia. A bone marrow biopsy might be compelling. Secondly, I would to suggest carrying out Anti-nuclear antibodies, HLA27 and autism antibodies for your symptoms are also very compatible with systemic lupus erythematous, which is an autoimmune disease. The symptoms as I said are very suggestive of a leukemia. An appropriate diagnosis is critical, for the setting up of an appropriate treatment plan. Delayed diagnoses my make the prognosis more faint. I suggest you book an appointment with the hematologist, to rule out a leukemia or any possible blood malignancy, and possibly systemic lupus erythematous. Thanks for your question and hope this helps, Luchuo, MD.