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Date of last update: 10/12/2017.

Forum Name: Hematology Topics

Question: red blood cell count, please help (updated 24th dec)

 kat - Thu Nov 25, 2004 7:37 am

hi there,

please can you help me in understanding my blood cell count that just came back. i will just list the abnormal ones.

haematocrit - 0.345 (lowest level 0.37)

RBC count - 3.71 (lowest 3.9)

WBC count - 2.8 (lowest 4.0)

red blood cell distribution width - 15.2 (normal 10-15)

neutrophil count - 1.2 (normal 2-8 )

what do u think these counts could suggest? what different blood tests or whatever would u think about doing? im a 20 year old female, just under a year ago was in hospital for 3 weeks with a mystery 'virus' and enlarged spleen, i had a bone marrow biopsy done but showed no abnormal cells. have just finished my 7th lot of antibiotcs this year since january and had to go into hospital again for IV antibiotics for cellulitis in my leg. but blood count hasnt shown any significant abnormality before. liver, kidney functions were normal and urine normal.

what can cause both the red cells and white cells to be low? even if we cannot diagnose the specific problem are there any treatments i could have to feel better?

any suggestions or input would be greatly appreciated thanks, kat xxx
 Dr. Yasser Mokhtar - Thu Nov 25, 2004 9:25 am

User avatar Dear Kat,

What was your platelet count on the complete blood count? Why was a blood count checked? What were the symptoms that you have been having?

In general, interpretation of any laboratory result has to be in the context of a clinical setting.

If all your blood counts are low, red cells, white cells (that you already have) and platelets (which you did not mention), then most probably the bone marrow (organ producing the cells) is inhibited by something. This could range from a simple viral infection upto serious disease such as cancer.

If your red cells are only low, this means that you have anemia, which could be related to lots of causes and according to the red cells' size and shape, the cause could be determined by doing further tests.

If your white cells are only low, this could be the effect of a drug, a virus or cancer.

If your platelets are low, it could be secondary to destruction (many reasons) or no production.

i think the most definitive way to finding out what is going on is to have a bone marrow biopsy but this is an invasive procedure and before doing it all other venues (in my opinion) have to be explored.

Waiting for your update.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Thu Nov 25, 2004 10:26 am

thankyou so much for replying so soon! i was hoping someone would as its really great to know that you can offer a bit of advice about this.

to some of the things u asked...

i don't know my platelet count, the nurse just reported to me the levels which were above or below the 'normal range' so i don't know if platelets were high or low within that range.

a blood count was being checked as the doctor said i probably had a urinary infection as i said i was drinking a lot and weeing quite a bit and felt unwell....the urine came back negative though and so did the glucose blood test.

i suppose to give you an idea of the context a bit more i shall explain...18 months ago i caught glandular fever again as i already had the EB virus when i was 7 (my doc was v surprised i could have it again and looked back at tests and said i had made no IGG to the virus or something). i became very unwell and had very enlarged spleen/liver and tonsilitis blocking my airway/throat...was hospitalised and had IV antibiotics/steroids. i continued seeing my doctor every 2 weeks who was surprised that my EB count remained very high for 10 months, he gave me valaciclovir (antiviral) and ferrous sulphate for mild anaemia. EB count came down and then i developed another 'mystery virus' last december and coughing all the time, weight loss, enlarged spleen, night proper diagnosis but i had a bone marrow biopsy which came back ok. i have taken imunovir (antiviral) since and my EB count has remained low so it isn because of this virus.

so i've been not feeling right at all since this happened a year ago and back in hospital for the cellultis and had other infections. i just feel very tired and a bit nauseaus, weak and achey, finding it very difficult to maintain weight and losing bit of weight, i weigh 45 kg and is hard keeping it up despite eating a lot.

you mentioned a few things which could cause white cells, red cells or platelets to be low individually, what could contribute to make both red and white cells to be low? i don't know about my platelets but im guessing they are within the normal range.

my doctor has requested me to have a repeat blood test in 1 months time, do u think this is soon enough?

also, if i pick up an infection with my white cells and neutrophils being this low, could i get quite a bit sicker faster?

thanks so much for your time, kat xxx
 Dr. Yasser Mokhtar - Thu Nov 25, 2004 1:53 pm

User avatar Dear Kat,

Thank you very much for the update.

i would assume that your platelets count is normal.

Since this appears not to be your first blood count, it would be better to ask about the trend of the red cells and the white cells counts, are the counts improving or getting worse? Are you still taking any medications?
Valacyclovir can rarely cause low white count, low red cell count and low platelets as well. i am not really familiar with imunovir to tell you about its side effects.

If your doctor that you are referring to is an infectious disease specialist, that's fine, if not, i would recommend that you be seen by an infectious disease specialist.

Neutophils normally consititute about 75% of the total white cell count. If the count that you refered to as neutrophil count is what is known as the absolute neutrophilic count then by definition (cut off is 1500/cc) it is low but worries start if the absolute neutrophilic count is below 1000/cc and the risk of infection rises greatly if the count drops below 500/cc and if you get an infection, you will most probably be a lot sicker than a person who gets the same infection, but with a normal white count.

The things that can cause white cells and red cells to be low together is either bone marrow depression or a combination of any cause of each like anemia for any reason and then getting a drug or a virus that can cause your white count to go low. The problem could just be that you are anemic, something that is not unheard of in females of your age, because of menstruation (and you have been sick as well) and you taking a medication that is causing your white count to be low and if the medication is stopped or the dose is lowered, this might improve things.

There are medications that can be given to make the white count go up if need be.

Remember, i am just standing outside and looking in, your doctor is the one who has been following you all along. You can take these thoughts to him as friendly suggestions.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Thu Nov 25, 2004 2:42 pm

thanks very much for replying again.

my doctor is my local gp, not an infectious diseases specialist they decided that i didnt need to see them anymore as i didnt have a persistant infection. ive been taking imunovir since march and blood counts were normal after taking it for months and when i had infection in the summer my counts were normal, up until about 3 weeks ago when my white cells started to show a dip. ah but thinking about it....i've had 3 lots of chloramphenicol this year, that can cause dips in cell counts can't it?

if it were an antibiotic or drug, is there any way to know if it was the effect of a drug? also if it were a drug im not taking at the moment and was taken as a week course?

i hardly lose much blood at all when i menstruate so i don't know if it could be that.

i guess i will just have to wait and see what happens with the results next time. i wish i had just seen one doctor all along then it might make things seem clearer but ive just been passed from different doctor for different things.

thanks a lot again for your time, kat xxxx
 Dr. Yasser Mokhtar - Thu Nov 25, 2004 3:25 pm

User avatar Dear Kat,

Thank you very much for the update.

Cholramphenicol can definitely cause this side effect.

i am not sure though how long its effect can last or when can it start.

Please, remember that the viral infection that you might be having may the cause of this and also the imunovir should not be excluded.

i would recommend that you see an infectious diseases specialist.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Fri Nov 26, 2004 5:52 am

are there any blood tests that can be done to see if it could be a drug side effect? like a test to see if there is a drug toxicity in my blood? like a general one or is that not possible? how can you exclude the possibilty of it being caused by medicine?

thanks again...sorry so many questions!!

kat xx
 Dr. Yasser Mokhtar - Fri Nov 26, 2004 8:29 am

User avatar Dear Kat,

i don't think that there is a specific blood test, unless a specific antibody against the drug in the blood that can be detected but this occurs in certain cases of being allergic to the drug.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Mon Dec 20, 2004 12:55 pm

hi there,

i thought i would update on what has been happening lately and ask or your thoughts on things.

after i posted on here last time i got an infection in my throat and a bit chesty, i went back to my doc and he said it was more likely since of the low white count and was viral. i had fevers and my tongue had horrible ulcers on it, i was being sick too. i went back and i had to see a diff doc and she gave me a paste for my ulcers and an anti sickness, i mentioned about the previous blood count and he said he would see how it goes but i may need a bone marrow biopsy and a look into my spleen or something. my doc said that in the next months blood count my white count should have come up a lot because of the infection. last week had the bloods taken and the results are:

WBC- 3.7

neutrophils- 2.2

esoinphils- 0.1

basophils- 0

lymphocytes- 1.3

HB- 11.2

haematocrit- 0.324

RBC- 3.36

MCH- 33.3

MCHC- 34.6


platelets- 241

red cell distribution width- 19

i looked up on the internet to find out if these values were within normal and it seems like im not anemic but the MCH is high. i know my white count overall has gone up a bit and my neutrophils have a bit like the doc thought but they still seem a bit lowish. what are your thoughts on this? it says the red cell distribution width measures the variation in size and shape of the red cells and mine is high, what could that suggest without being very anemic? would you think a bone marrow biopsy would be advisable with whats been happening? any other thoughts would be gratefully appreciated.

my doc has asked me to come in for an appointment to talk about the results so will see what he says, im going tomorrow.

thanks, Kat xxx
 kat - Fri Dec 24, 2004 4:48 am

i went to see my gp yesterday as requested, he said that he thought my lowish wite count should come up more and is nothing to be concerned about, that my low red counts are nothing to be concerned about either. i told him that my spleen felt a little uncomfortable when i laid on my side and he didnt comment and didnt examine me. i feel quite annoyed really...he said that maybe my low white counts are just normal for me and i told him that this isnt normal for me because my white counts have always been good and normal as well as my red counts...he doesnt seem to be interested in ruling out any other causes and said that when it was low i probably had an infection but i didnt i did have ulcers in my mouth and then i got a bug, the ulcers went for a week and a bit and that was when my result was up a bit and now the bug is gone my ulcers are back and i suspect its dropped again...but i don't want to appear like im telling him hes not doing his job right. he sugested i take some iron but i already take iron and from looking at the results my red cells are high end normocytic to macrocytic and the anemia is very slight.

anyway so i just have to have a repeat blood count in another month....i just hope if it comes out low again and my haematocrit or red cells have fallen any more that he wont just turn me away again.

what are your thoughts? please reply i really need some advice.

thanks, Kat xx
 Dr. Yasser Mokhtar - Sun Dec 26, 2004 11:05 pm

User avatar Dear Kat,

Thank you very much for the update.

The ulcers on your tongue and the sore throat were most probably secondary to the low white count causing a viral infection (of the throat) or a fungal infection (of the tongue).

Enlarged spleen is an anatomical description but an enlarged spleen can be also hyperactive and causing low blood counts but the platelets are the ones that should be low first because they have a short life span as compared to the other blood cells, so most probably this is not a hyperactive spleen.

There is an entity called cyclic neutropenia where, on regular basis, the white count decreases and then comes up on its own but you don't seem to fit this as your white count has always been ok and you never mentioned that you had repeated infections when you were young.

You never mentioned whether the dose of the imunovir was changed?

If this continues to be a problem i would recommend that you see an infectious disease specialist and a blood disease specialist.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Tue Dec 28, 2004 7:05 am

hi there,

thanks so much for replying :)

yep i think you are right about the cyclic neutropenia i have never had this problem before with low cell counts so is probably not that. i have had problems with infections when i was younger though, however i never had problems with my cell counts. i was referred to a infectious diseases specialist when i was 7 who diagnosed me with glandular fever/ epstein barr and i had other infections including having chicken pox twice and then like i mentioned earlier i was infected with EB again and other stuff over the years....i had seen him up to last year but was then passed onto other doctors.

it is so complicated when you have a paed doctor when you are young and they know your history and now i was passed onto adults they have basically stopped seeing me and not doing much. its quite frustrating but i feel like i don't want to make a fuss and go back to my old paed doc as my other doctor who i was passed onto (even tho i never see her) said that i shouldnt see my paed doc now coz ive been referred to her. to make things more complicated i havent seen this doc for like 6 months and in the mean time i had some infections so had to see my gp who i had the blood tests with and found the low ish counts!!

do you think i should see if i can see my old paed doc again who knows my past and is always very thorough? i know if he saw my results he would do the correct tests to see if they can treat me for whatever...or should i see the doc who i was referred to who is reluctant to do tests but as im now an adult she is my hospital doctor?

ive got a repeat blood count on the 20th of January and if they come out low again and my gp says again 'maybe this is normal for you' i may ask him to refer me to a haematologist.

thanks, i'd appreciate any thoughts or suggestions.
Kat xxx
 Dr. Yasser Mokhtar - Tue Dec 28, 2004 11:04 am

User avatar Dear Kat,

Thank you very much for the update.

i don't think you have to go back to your pediatrician, and let's wait and see what is the next blood test going to show.

i am not really an infectious disease specialist or a hematologist but i am not sure whether or not the cyclic neutropenia can start affecting people at an older age.

You never said what happened to the imunovir?

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.
 kat - Thu Dec 30, 2004 6:26 am

the imunovir dose hasnt been changed, i was supposed to be taking 3 a day but my doc (this is a different doctor who i saw at the hospital- different from my gp or paed) said that i could take 2 still, i saw her after my leg infection and she said it must no be helping but im still taking it, she said that it cant do any harm.

i'll update again if i have any news, thanks very much.

Kat xx
 Dr. Yasser Mokhtar - Thu Dec 30, 2004 11:21 am

User avatar Dear Kat,

Thank you very much for the update.

i would strongly advice that you at least talk to your infectious disease doctor to ask him about how long you should be taking it and when it is adviced to stop it and if you are still taking the valacyclovir, if there is a chance that imunovir can interact with it increasing the effect of valacyclovir on bone marrow depression.

Also, how about a new eb virus blood test to see whether or not you have a reactivation that might be the reason behind all this.

Thank you very much for using our website and i hope that this information helped.

Yasser Mokhtar, M.D.

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