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Doctors Lounge - Hematology Answers

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Forum Name: Hematology Topics

Question: High Monocytes and low Neutrophils


 lasond2471 - Thu Jan 15, 2009 8:50 pm

I have been very ill for over a year. I eat a healthy diet and have always been slender and fairly muscular. My symtoms started vague with just not feeling well in spells. I would get very tired and chilled to the bone for no reason then feel normal again. I was diagnosed about one month later with a severe UI. After being treated with antibiotics the feeling of unwellness went away for about 1 month then returned with a greater severity. In the past year I have had several infections to include a bad tooth abscess that I had for the past 8 years and 3 bloody sinus infections and gastritis that I get almost annually and none of thes infections were treated appropriately if at all. I have gained 10 pounds that I cannot get rid of reguardless of excersise and diet. Approximately 4-5 months ago, I was awakened out of my sleep feeling bad, weak and with pretty bad heart palpitations. After my ER visit I was told that I was in good health and nothing abnormal was to be reported. I was sent home just as sick as before my visit. I requested my tests to see what the report contained and found that my hematology test concluded:
Neu% 36.7 out of 40.0-80.0 and Mono% 10.3 out of 2.0-10.0. I am floored that this was not looked into further and to this day am still suffering from the same symptoms and have had no luck in getting assistance or futher testing by any doctor other than 3 CBC and 1 thyroid test that came back normal. Any help you can give me will be greatly appreciated.
 John Kenyon, CNA - Thu Mar 12, 2009 10:08 pm

User avatar Hi there --

While there's little doubt something is wrong that would have to account for your lowered immunity and frequent illnesses, the bloodwork you had done was so close to the normal range that I'm really not surprised it wasn't followed up, even though in a private practice it probably would have been. Those numbers are right along the lower and upper ranges of normal, respectively, and wouldn't likely account for your problems over the past year, so this is why you weren't worked up more thoroughly via the ER. Even if these findings were sent to your regular doctor, they would not, in themselves, have been likely to raise any red flags.

Further lab work is certainly in order, but of a more exotic nature. I think an ANA titer, complete metabolic panel (CMP), monospot and second CBC, at least, should be done, along with a very thorough history and physical (H&P). You may have something viral that's worked as a drag on your immune system while causing some symptoms of its own (Epstein-Barr virus/mono come to mind, along with a number of others). Hopefully you can persuade your GP to do this. If not, then it's time for either a second opinion or a change of GP.

I hope this is helpful. While I don't think you have anything extremely serious to be concerned about, the chronic, seemingly random illnesses certainly have to have been exhausting emotionally as well as physically, and I'm pretty sure there's a medical path toward managing this and correcting what's wrong , but it will require lab work and an interested physician. Often, unfortunately, with this sort of thing, one complaint arises at a time and seems inconsequential, so the patient is just listed as "sick" and sent on her way. This is very unfortunate and I do hope you're able to find someone willing to work with you on finding any underlying cause and setting up a plan of care so you can begin to feel like yourself again.

I hope this is at least helpful to you. Best of luck with this and please follow up with us as needed.
 lasond2471 - Fri Mar 13, 2009 6:56 pm

John, I really appreciate your response. You have given me more hope that I'm closer to diagnosis than with all 4 doctors that I have seen in the past year and a half. I am currently talking with a lady who has practiced natural medicine for almost 25 years and she seems to think that the dull knawing sensations under my right breast that occurs before all the other symptoms I described earlier indicates a fatty liver as well as stones in the liver. I will be sure and post again in a couple of months, hopefully to report a full diagnosis and recovery. Again, thank you so much.

All the best!
 John Kenyon, CNA - Sat Mar 21, 2009 9:52 pm

User avatar I'm so glad the response was at least in some way helpful to you. Your natural medicine person may just be on to something -- it's entirely possible -- and I'll be looking forward to any update regarding this. A fatty liver is a pretty benign thing generally, and stones are a fairly simple problem to correct. It's certainly worth exploring.

Good luck to you and thanks for the update. We'll be here waiting to hear more, and hopefully good, news. Take care. And you are very welcome!

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