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Forum Name: Hematology Topics

Question: Raised WCC and lymphocytosis


 Sleepy-Jo - Sun Nov 09, 2008 12:50 pm

Hi,

For the past 12 months my lymphocyte count and WCC have been raised (Lymphocytes between 4.1-4.5). The last 2 blood films have shown 'atypical' lymphocytosis, however I do not have an active EBV infection. My most recent blood count has come back showing lymphocytes 6.1, MCHC raised, Hb normal (I think) and overall WCC raised (as a result of the increase in lymphocytes I presume). I have been screened for EBV, CMV, toxoplasmosis, a multitude of other viral causes, however results suggest I do not have an active infection. I suffer with tiredness (sleep around 12-14 hours a day), fatigue, nausea and intermittant diarrhoea, fainting, muscle stiffness, itchy tender skin which breaks out in tiny purple dots if I scratch and generally feel quite unwell. I have been told not to worry and that my symptoms are coincidental and not as a result of these blood abnormalities, symptoms probably due to chronic fatigue. Can these results be normal for a subsection of the population?

Many Thanks
Kelly
 Dr. Safaa Mahmoud - Mon Nov 10, 2008 1:32 pm

User avatar Hello,

The clinical picture you described would make me think of an allergic condition or hypersensitivity as a poosible cause.
A wide variety of allergens can cause increase in the number of lymphocytes as well as the appearance of skin rash or follicles. These include medications, exposure to certain organisms, dust etc.
The mechanism underlying asthma itself involves lymphocytes and monocytes and their presence at a high level. Your history and your family history of asthma are supportive for this possibility.

The medications your on right now have been reported to cause skin rash, dermatitis, and urticaria although less common and mostly occur early in the course of therap.
So, you may be allergic to different types of allergens and not completely controlled with these medications, that may explain the blood results in a way.

Absolute lymphocytosis is defined by an absolute lymphocyte number is greater than 4000/mcl.

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.
How about your blood level of CRP, ESR, LDH? It would be helpful if you can inform us about them.

However, serious causes like chronic lymphocytic leukemia should be excluded especially in very high lymphocytic counts (less likely as your blood smear was not suggestive). Blood smear (blood film seen under microscope) 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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