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Forum Name: Hematology Topics

Question: "Wait and See" or act now??


 stumpedNSJ - Wed Aug 24, 2005 4:19 pm

Hello,
I recently saw my PCP because of frequent exhaustion and irritability. I had the standard CBC performed and had the following results:
Neutrophils = 32
Lymphocytes = 54
Absolute neutophils = 1.2

I was told that these were strange results and i should be retested which i was. I was told by phone that my new absolute netrophils was 1.0. My doctor wants to wait 1 month, retest, and if it is "abnormal " then send me to a hematologist. Additionally, I have a Trace amt of blood in urine seen in urinalysis. The only other symptoms I informed the doctor about are:
lower back ache, frequent exhaustion, bleeding gums(not normal for me) and very frequent canker sores in my mouth over the past year. Normally I get them about 1-2 times per year.
Does this sound like normal protocol or should I be concerned? Any opinion will be greatly appreciated.
 edcarta - Thu Aug 25, 2005 8:23 am

Hi Stumped,
I've been dealing with what you have described for over 2 years and have done a lot of reading. My Dr. followed the same course yours is following. If your absolute neutrophil count resolves, it can be something as simple as a viral infection. If it doesn't, I found a lot of info on http://www.neutropenia.ca.

My case is the Neutropenia topic and I most recently posted today as I went to the hematologist yesterday.

Please post your progress.

Best wishes,
Edcarta
 stumpedNSJ - Thu Aug 25, 2005 9:07 am

thanks, EDCARTA... I appreciate your input. I'll post a follow-up when I know something.
Good Luck to you !

StumptedNSJ
 stumpedNSJ - Wed Sep 14, 2005 4:08 pm

So I just got back my 3rd CBC results and I am beginning to worry. It has been 4 weeks since the last test and basically the results are similar. My doctor has ordered an HIV test which got me completely crazy. Does anyone know of any other illnesses besides HIV that could cause low neutrophils and high Lymphocytes? I am being referred to a Hemotolgist next week in the meantime. Any reassurance would be welcome at this point.

My results are as follows:

White cell count 4.5 (3.8-10.8)
Red Cell 3.85 (3.80-5.10)
Hemoglobin 12.9 (11.7-15.5)
Hemocrit 36.8 (35 - 45)
MCV 96 (80-100)
MCH 33.4 ( 27-33) High
MCHC 35
RDW 13.7
Platelets 200
MPV 8.6
Neutrophils 25 (40-75) Low
Lymphocytes 64 (20-45) High
Monocytes 9
Eosiniphils 2
Basophils 1
Absolute Neutrophils 1.1 (1.50 - 7.80) Low
 stumpedNSJ - Mon Oct 03, 2005 8:18 pm

I have finally seen a Hematologist who ordered yet another CBC to be done on a slide while I waited. The results are still the same. She has asked me to come back in another 6 weeks and, in the meantime, I am to try to get all past test results from old doctors to make a comparision.
I am still fatigued have frequent diarrhea and have terrible lower back and shoulder pain during the night and first thing in the morning. Other than that, not much to complain about.

PS- HIV test negative

Thanks for listening,
stumpedNSJ
 stumpedNSJ - Wed Nov 02, 2005 2:45 pm

Hello,

I am hoping that someone has been following my post who can give me a professional opinion. I just saw the Hematologist again today as a follow-up. My cbc came back all normal accept for Lymphocytes slightly high.

According to my past bloodwork done over the past few years, it looks like my White Blood count dropped signifigantly in 2003 and has persisted until now. The Hema. wanted to recheck me in 3 months, at which time I will be tested for Lupus, Rheumatoid Arth. amongst other things. I was told that if my numbers continued to be normal, then I am fine.

I guess my questions are, 1) is this something to be concerned with? 2) Do I need to seek a second opinion? 3) Am I overreacting? 4) Could stress cause this "dip"? Is it possible to have such a long period of low readings and then bounce back to normal and everything is fine?

I would really appreciate a reply post so I can "put my concerns to bed" for now. Sometimes, reading all of these posts can be overwhelming.

Thank you,
Stumpednsj
 stumpedNSJ - Fri Feb 17, 2006 2:55 pm

Please respond.... I was recently retested by my Hematologist to watch on-going Neutropenia. the results came back low again:
Neutrophils - 24
Lymphocytes -65

This was a 3-month check. 3 months ago the test was normal, now it is low again. The hematologist wants to test me agian in 3 months. Can it be that these are "normal" numbers for me?? How long do I need to be tested like this before we can rule out anything terrible?? Please read my earlier posts to follow what has been going on.

Your input is GREATLY appreciated!

-stumpednsj
 stumpedNSJ - Tue Jul 11, 2006 6:27 pm

For anyone who may be interested, I finally have an answer for my Neutropenia. I went to another Hematologist for a second opinion who thought it would be wise to have a bone marrow biopsy done. He was able to determine that I have autoimmune neutropenia at this point and, while I do not "qualify" for a diagnosis of T-Cell Large Lymphocytic Leukemia due to my level of neutropenia, I do have all the pieces in place for it. It was the genetic testing and flow cytometry tests which determined this.

My igG result came back high at 1770 mg/dl. Also the T-Cell clonality test came back positive. The final report read as follows:
"Moderate Lymphocytosis"
"Modest increase in CD3+/CD8+/CD57+ Large Granular Lymphocytes, T-Cell"
"Lambda predominant Plasma Cells"
"No monoclonal B-Cell population"

I have tested negative for RA but my grandmother had it. So at this point, I do nothing and I will be monitored every 3 months. Does this sound familiar to anyone? there is not a lot of info out there on this type of condition and how it may or may not progress.

-StumpedNSJ
 Dr. Safaa Mahmoud - Wed Jul 26, 2006 3:36 pm

User avatar Dear stumpedNSJ,

There are four lymphoproliferative disorders affecting Large granular lymphocytes (LGLs):
reactive/transient LGL expansion,
chronic LGL lymphocytosis,
indolent LGL leukemia, and
aggressive LGL leukemia.

Criteria for diagnosis of LGL leukemia:
Abnormal monoclonal proliferation of CD8+ T cells in patients with cytopenia.
The classic immunophenotype of the malignant T cell in LGL leukemia is CD3+CD4–CD8+CD16+CD27– CD45R0–CD57+CD94+.

Atypical lymphocytosis occurs cases of viral infections e.g.
In Epstein-Barr virus (EBV) infection; the atypical lymphocytes are not CD57+.
A common association between LGL leukemia and other systemic diseases like: Autoimmune diseases, Hematologic disorders, Other malignancies.

LGL leukemia is an indolent chronic disorder. Spontaneous remissions have been reported in some studies.
Recurrent neutropenia and infections are the main concern in treatment of this disease.

I hope you find this information helpful.
Best regards,

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