<s>[INST] 34 year old female with elevated white blood cell count after month of vancomycin treatments. Leukocyte alkaline photophase test came back elevated as well as elevated liver enzymes. severe fatigue with  occasional left rib pain and some hip pain...any suggestions? [/INST] Hi,Thanks for asking.Based on your query, my opinion is as follows.1. Elevated white blood cell count possibly indicates inflammation. Liver enzyme elevation indicating liver injury could be the cause.2. Leukocyte alkaline phosphatase score is elevated due to white cell count. 3. Exact counts is necessary along with evaluation of Arneth count to evaluate for leukemia or inflammation. Severe fatigue with bone pain indicates possible associated anemia. Check for hemoglobin levels.Hope it helps.Any further queries, happy to help again. </s>