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Forum Name: Hematology Topics

Question: Elevated Absolute Lymphcyte Count


 LMASC - Tue Jul 20, 2010 1:46 pm

Hello,

I am a 40 y.o. female with possible Sjogren's Syndrome. Otherwise, I am in reasonably good health. Recently, I had labs drawn with the following results:

WBC 8.2
RBC 4.03
HGB 12.2
HCT 36.4
Platelets 247
Polys 54
Monos 4
Eos 2
LYMPHS 40 (range 25-45)
Absolute LY # 3.5 (reference range 1.3 - 2.9 10*3/uL) HIGH RESULT

I'm not certain what, if anything, this elevated absolute lymphocyte number means. Is this considered absolute lymphocytosis and if so, do I need to push back on my doctor for further testing? All other labs were normal, as you can see from above.

Thanks in advance for your help.
 Dr.M.Aroon kamath - Wed Jul 21, 2010 2:38 pm

User avatar Hi,
Thank you for the post.
I will refer you to the following link wherein i have a similar query and you may find the information that may be of help.
(viewtopic.php?f=62&t=47530&hilit=+lymphocyte+count)

Best wishes!
 LMASC - Thu Jul 22, 2010 3:38 pm

Thank you, Dr. I am still a bit confused, however. After reading through the information in the URL you provided to me, am I to assume that a 3.5 result would not be considered absolute lymphocytosis?
 Dr.M.Aroon kamath - Mon Jul 26, 2010 1:12 pm

User avatar Hi LMASC,
Thank you for that interesting observation. The laboratory reference ranges indicate the values most supposedly "normal" people in a given population will have.So,it is probable that some may have values slightly above or below a given range.

The laboratory reference ranges for 'normal' values vary between various laboratories.

To take the example of the absolute lymphocyte count, some examples of the normal rages(all values/mm3) quoted are such as,
1000-3000(mostly),1000-3500,1000-2900,900-2900,800-2600,
1000-3500 and so on.
What finally matters is that the accepted definition of lymphocytosis which is when the count is >4,000/mm3.

It is defined that way perhaps because, most individuals with diseases causing significant lymphocytosis tend to have values >4,000/mm3.

Thus, to go by your laboratory's reference range, you do have a absolute count higher than upper limit of normal but, still if one adheres to the strict definition, you fall short.

Importantly, one should never treat laboratory values. The values should always be viewed in the context of the clinical picture.
Best wishes!
 LMASC - Thu Jul 29, 2010 2:51 pm

Thank you again, Doctor. Just two last questions:

Is it possible for Sjogren's Syndrome to cause an elevated absolute lymphocyte count, an elevated relative lymphocyte count, or both?

Based on my labs and in the absence of any other symptoms, should I be concerned at all about Lymphoma or Leukemia? My understanding is that Sjogren's does put me at increased risk for Lymphoma, but I am not sure if there is any increased risk for Leukemia?

I'm just not clear as to when elevated counts become 'concerning.' I would assume that absolute lymph counts would be quite high where Leukemia is concerned, but perhaps you can verify that for me.
 Dr.M.Aroon kamath - Sat Aug 14, 2010 2:30 am

User avatar Hi LMASC,

Relative lymphocytosis is fairly common in primary Sjögren's syndrome and is usually of no clinical significance. This picture is an apparent pnenomenon because many patients with this syndrome have mildly lower absolute neutrophil counts.

There have been isolated reports of
- patients with primary sjögren's syndrome and T cell large granular lymphocyte (LGL) leukemia.
- primary sjögren's syndrome associated with other lymphoproliferative disorders that have chronic lymphocytic leukemia-like properties (CD5+ CD20+ cells), and
- primary sjögren's syndrome with B-cell lymphoma with circulating B-cell (usually CD20+ CD5-) monoclonal cells.


Sjögren-like syndrome (SLS): SLS presents clinically with salivary gland enlargement, xerostomia and keratoconjunctivitis sicca.It is believed to be caused by an HIV-induced immune dysregulation.

I hope this information may be useful to you.
Good luck!

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