low WBC and neutrophils with high lymph and ferritin

[KBH4466]

My symptoms are fatigue, abdominal pain and joint pain for 4+ years. During that time I have had 5 CBC's with low WBC's of 4.0-4.5 (Ref. 4.8-10.8), low neutrophils of 1.77-1.89 (Ref. 2.16-8.0),and high lymph % of 45.2-49.3 (Ref. 16-45). Recently I had Iron of 134 (Ref. 35-100) and Ferritin of 373 (Ref. 8-244). CRP was normal and Sed Rate was 1 (Ref. 0-15) to rule out inflammatory processes. What tests/illnesses should I be discussing with my doctor?

[Dr. Safaa Mahmoud]

Hello,

Normal values for while blood cell and its elements are:
White blood cells: 4,500-10,000 /mcl.
Neutrophils: 40% to 60%
Lymphocytes: 20% to 40%
Monocytes: 2% to 8%
Eosinophils: 1% to 4%
Basophils: 0.5% to 1%
Band: 0% to 3%

An absolute neutrophil count ANC is a real number of neutrophil count in relation to the total white blood cells (WBCs). The normal range for the ANC is 1.5 to 8.0 (1,500 to 8,000/mm3). Lymphocyte Count (Absolute) range is 1000 - 3500/mm3.
An ALC over 4,000 indicates lymphocytosis.

So, your blood count results are not considered alarming or at least at abnormal levels that are indicative of a serious illness, however, exclusion of all serious causes is essential . Some viral infections and allergic conditions may result in clinical picture similar to yours.

Other tests known to be elevated in tissue damage and inflammatory conditions are ESR, LDH and CRP. Ferritin is also considered an acute-phase reactant that is elevated in the course of a disease usually together with other acute phase reactions (elevated C-reactive protein and ESR).

Normal level of iron is in the range of 60-170 mcg/dl. Although the level of iron in your blood is mildly elevated, it is not alarming especially if all other parameters are within normal and you are on iron supplements.

Iron is stored in the form of ferritin. Levels of ferritin can be high in cases of: increased iron absorption (genetic disorders), following excess iron intake or blood transfusion, blood hemolysis or damage in certain organs.

Liver, spleen and the bone marrow are the main sites to store ferritin. Thus liver diseases, band lood diseases including leukemia although seems unlikely in your case.

Infections and inflammatory conditions like autoimmune conditions, arthritis, myoskeletal problems or infections are associated also with high ferritin level mostly with normal level of iron.

Hypothyrodism (most likely to be the cause) results also in abnormal blood counts especially if the underlying cause is of inflammatory nature or autoimmune disorders like Hashimoto's thyroiditis. Patient with thyroid hypofunction may complain of fatigue, muscle and joint pain. Arthritis is commonly seen also in patients with autoimmune thyroiditis.

Since your results are not conclusive of any specific illness, serial follow up of your blood count together with a thorough history and clinical examination may be more helpful in determining the possible causes and the needed investigations.

I would advise you to follow up with your doctor and to discuss with him all your concerns. He might recommend thyroid function tests, liver function tests, to repeat CBC,CRP, ESR after aperiod of time.

Hope you find this information useful.
Please keep us updated.