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Forum Name: Hematology Topics

Question: Lymphocytosis- low neutrophils - enlarged lymph nodes


 kate91308 - Fri Nov 07, 2008 1:42 am

I had some lab work done and it came back that i need to see a hematologist but i cant get in for 2 weeks so i was hoping to get an opinion in the meantime
my white blood cell count was 11000
lymphocytosis with 59% normal (24 to 44)
19% neutrophils normal (41-71)
17 % bands (0-6)
hemoglobin 13.6 (12-16)
platelet count 225000 (150000-400000)
kidney and electrolytes were normal
liver tests
ast 41 (8-40)
ldh 220 (84-212)
c_reactive protein 1.2 (0-1.3)

CMV/IgG negative
CMV/IgM negative
Epstein-Barr negative

my lymph nodes in my neck are swollen the biggest about the size of a bean in the middle of the side of my neck

what can you tell me with these results
 Dr. Safaa Mahmoud - Sat Nov 08, 2008 1:04 pm

User avatar Hello,
If you have a normal white blood count but low neutrophil, the increased percentage of lymphocytes is not considered true elevation and is named relative lymphocytosis. This is true as long as the absolute lymphocyte number is not greater than 4000/mcl.
So, your absolute lymphocyte count is considered truly high since it exceeded 4000/mcl . Your absolute neutrophil count is within the normal range although the percentage is less than normal. Neutropenia is defined by an absolute neurophilic count less than 1500 cells/mm3.

So, your main problem is absolute lymphocytosis with a total while blood cells count in the high normal.

Common causes of lymphocytosis include viral (e.g. influenza) and bacterial infections. That is why your doctor wanted to exclude viral causes by the tests he recommended since it is a common cause for lymphocytosis. Your CRP is also suggestive of inflammatory condition but this is not specific and is not that high to allow any conclusion. If you have suffered from any recent illness like sore throat, sinusitis, dental or oral infection or inflammation this could be the cause of these results.

In addition enlarged nodes are commonly seen in this part of the body due to inflammations and infections in the oral cavity and nasopharynx. After recovery from infections they regress in size but remain palpable. They are non specific if small <1cm, mobile, soft to firm and are not increasing in size or number.

However, serious causes like chronic lymphocytic leukemia should be excluded especially in very high lymphocytic counts. Blood smear (blood film seen under microspcope) is very helpful in the diagnosis. If leukemia is suspected bone marrow examination should be done.

I would advise you to follow up with your doctor. Only by thorough history and physical examination the proper diagnosis can be reached.
Please keep us updated.
Best regards.

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