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Forum Name: Hematology Topics

Question: Gradual increase in white blood cells


 knj822 - Wed Aug 10, 2005 1:15 pm

My mom has had a cbc done 3 times since January.
Her wbc count has been elevated in all three tests (not horribly elevated but average 12-13k)
Her mcv has been low on all 3 (about 76. Normal range from lab 80-100)
her MCH is around 25.4 on all 3 (lab normal range 27-33)
rdw : 15.7 in Jan 15.9 in Aug (normal 11-15)
lymphocytes are : 5029 in january
6634 in May
5222 in August
(normal lab range 850-3900)
mpv was normal in first 2 tests and is slightly low now.
monocites were low in May and are normal now.

Another thing her dr. circled on the lab report is that although her neutrofils are within normal ranges they are steadily climbing. Don't know if that is important or not.


Her dr is sending her to a hematology consult but in the meanwhile I was hoping someone could tell me what these numbers could indicate.
Her history is gallbladder problems (stones) and she recently had a mass show on a mammogram but was told it was a benign cyst. She is going this week to a surgeon for another opinion on that.
Also her Aunt had leukemia years ago if that is an important detail.
(her dr told her the hematologist might do a marrow biopsy which is why I am mentioing the leukemia history in the family)

Thanks for any imput anyone could provide!

Kim
 Dr. Tamer Fouad - Thu Jan 26, 2006 5:46 pm

User avatar Hello,

I hope that your mother is feeling well by now.

Lymphocytes are small, mononuclear cells that migrate to areas of inflammation in both early and late stages of the process. They play an important role in immunologic reactions.

Normal lymphocyte count is in the rage between 16-45% of white blood cells (WBCs). Increased lymphocytes (lymphocytosis) in adults is defined as an absolute lymphocyte count greater than 4,000/mm3.

Lymphocytosis can be either primary or secondary. The reactive, or secondary, lymphocytoses are conditions that involve absolute increases in lymphocytes caused by physiologic or pathophysiologic responses to infection (especially viral), inflammation, toxins, cytokines, or unknown agents.

Lymphocytosis is also associated with stress and consequent release of epinephrine, such as that seen in patients who have had cardiovascular collapse, septic shock, sickle cell crisis, status epilepticus, trauma, major surgery, drug reactions, or hypersensitivity. Persistent lymphocytosis may be seen in patients with autoimmune disorders, sarcoidosis, hyposplenism, or cancer and in those who are long-term cigarette smokers.

Primary lymphocytosis, often called lymphoproliferative disease, include the leukemias, the lymphomas, and monoclonal B cell lymphocytosis.

Primary bone marrow disorders should be suspected in patients who present with extremely elevated white blood cell counts or concurrent abnormalities in red blood cell or platelet counts. Weight loss, bleeding or bruising, liver, spleen or lymph node enlargement, and immunosuppression also increase suspicion for a marrow disorder.[1]

Her doctor wants to rule out the primary bone marrow disorders outlined above, the reason being the progressive nature of her leukocytosis and the presence of persistant absolute lymphocytosis.

References:
==========
Abramson N, Melton B. Leukocytosis: Basics of Clinical Assessment. Am Fam Physician 2000;62:2053-60.

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