<s>[INST] Hi,  My niece who is 20 has an ESR of 140. The reason for her to go to doctor was a persistant allergic type of cough. Her chest x ray ia normal. Her TLC is also high abt 16000. Now they r going to do many further tests. My sister is very upset. Can it be due to the cough or some other serious illness? [/INST] Thanks for your question on Chat Doctor. I can understand your niece s situation and problem. ESR (erythrocyte sedimentation rate) is marker of inflammation. So high ESR suggest presence of inflammation. TLC (total leukocyte count) is raised in infection, mostly bacterial infection. So possibility of bacterial infection is more in your niece s case. She is having coughing with normal chest x-ray. So possibility of Upper respiratory tract infection like tonsillitis or pharyngitis is more. So ask your sister not to panic much. Take her to the doctor and start antibiotics. She also needs antihistamines and anti-inflammatory Chat Doctor.  Ask her to  </s>