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Forum Name: Leukemia

Question: CBC Differenital


 charliesmom - Sat May 12, 2007 4:36 pm

Hello. I am a 24 yo female, currently diagnosed with "inflammatory arthritis" and obstructive sleep apnea. I was diagnosed with arthritis 1 year ago after experiencing crippling joint pain & fever.

I have currently been experiencing an abnormal amount of fatigue, increasing joint pain & fever. The fatigue is quite debilitating, I am unable to preform 10-20 minutes of any activity without having to lay down & rest & I could sleep all day every day despite how much sleep I received the previous night.

I have been concerned that there is more than just arthritis going on since the exacerbation of symptoms began & recent bloodwork has increased my concerns, especially when compared to a CBC that was done a year ago. I have a family history of leukemia, but I am not sure what type.

My recent CBC differential results:

WBC - normal at 7.1
Platelets - normal at 295
Neutrophils = 30.0% (reference range of 37-75, test 1 year ago showing level of 62.3%)
Lymphocytes - 56.1% (reference range of 12-50, test 1 year ago showing level of 26.2%)
Monocytes - 10.3% (range of 0-10, 1 year ago 6.8%)

I agree with my doctors that there is some type of arthritis occurring, as I have some joint deformities to both hands. My PMD, however, seems concerned that there is something more ocurring, but cannot decide what is going on. I know arthritis can be debilitating, but what I am experiencing has been relentless for the past year, with no flare-remission periods, only ever-increasing symptoms.

I have never had a + rheumatoid factor, or + ANA, only a + HLA-B27 test, and a bone scan that shows abnormal activity in almost every joint. I have been tested for HIV & hepatitis, both of which were negative. My ESR/CRP have been in the normal range, with only 2 execptions, at which point they were only mildly elevated.

My current medications:
Humira injections 40mg every week
Sulfasalazine 3gm/day
Relafen 500 mg/bid
Mobic 15mg/day
Folic Acid 1 gm/day
Ambien 10mg/day
Prednisone bursts as needed, none taking around time of recent CBC

I am hesitant to voice my concerns to my physician as I don't want him to think I am overreacting, but the fatigue & pain has become very debilitating, and honestly, I am beginning to feel a sense of impending doom. Is it possible my abnormal blood studies are simply due to medication? I know that are not significantly abnormal, I am just feeling SO awful. I was not ill with any type of infection at the time the test was preformed.

I have knowledge of medical terminology, as I am an ER nurse, so any opinions/replies would be greatly appreciated.

Thank you.
 Dr. Chan Lowe - Sun May 13, 2007 7:50 pm

User avatar Based on what you have described I think leukemia is unlikely. Your CBC differential is only mildly shifted towards lymphocytes and away from neutrophils. It may be that your body has recently fought of a virus.

The arthritis you are describing sounds very suspicious for rheumatoid arthritis. This disease can have systemic symptoms. I would strongly recommend you see a rheumatologist for an evaluation to see if you can be put on a different treatment that may help bring your symptoms under control.

Best wishes.

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