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Date of last update: 10/12/2017.

Forum Name: Hematology Topics

Question: High RDW, High Basophils and Myelocytes found

 wendyherself - Tue Jun 15, 2010 6:50 am

Good morning! I recently had blood work done through a weight loss clinic. I received a copy of my results yesterday (with no explanation) and am wondering if I should find a regular primary doctor to review them.
I have Iron Defiency Anemia and have controlled it with Iron supplements.

My test show the following:
WBC = count good, but deterioration noted on the blood smear
RBC = Minor variation in shape, crenated RBC's, Anisocytosis present
Lymphs = atypical lymphocytes
Basosphils and Absolute Basophils = high
RDW = High
Myelocytes = High

Is all this related to the anemia? What course of action would you recommend?

Thank you for your time.
 Dr.M.Aroon kamath - Sat Aug 14, 2010 8:29 am

User avatar Hi,
Unfortunately, your post is devoid of any detail.

There is no information about the actual levels or percentages of the various tests and no details about hemoglobin level or the peripheral blood smear study as well. Therefore, i am left with no option other than to provide some general background information.

Whenever myelocytes are seen in a peripheral blood film, the important next step is to find out if they are
- neutophil myelocytes
- eosinophil myelocytes, or
- basophil myelocytes.

Neutrophil and eosinophil myelocytes can occur both in reactive conditions and in certain leukemias. Basophil myelocytes essentially occur with leukemias.

An Schilling count may be useful to determine if there is any 'shift to the left'.

The term left shift indicates that there are increased numbers of circulating immature neutrophils (band cells +/- metamyelocytes, myelocytes).

A regenerative left shift is characterized by band cells(immature neutrophils) with leukocytosis. However,the number of immature neutrophils does not exceed 10% of the neutrophils, and no young cells, such as metamyelocytes, are present.This is seen in acute infections(usually bacterial).

A degenerative left shift is characterized by circulating band cells >10% in conjunction with absence of leukocytosis, with or without the presence of precursors (metamyelocytes or myelocytes) . A degenerative left shift is often an unfavorable prognostic sign.This may be seen in relation to overwhelming infections, myelodysplastic diseases or in leukemias.

A condition wherein immature nucleated red cells in addition to left-shifted neutrophils and at times even neutrophil precursors (metamyelocytes, myelocytes, promyelocytes), are thrown into the blood by the bone marrow in response to certain insults.

If this is seen in a case with severe anemia (or thrombocytopenia), then it is likely to be a response by a overzealous bone marrow to iron deficiency anemia.
On the other hand, if this response is seen with normal hemoglobin levels, then other causes such as a metastatic carcinoma (osseous), or a leukemia is often the cause.

The atypical lymphocytes are difficult to explain. There have been case reports of Myelodysplastic syndromes and Lymphoproliferative disorders occuring simulteneously.
"Concurrent Myelodysplasia and Lymphoproliferation: a Disorder of the True Pluripotential Stem Cell?"
(Q J Med 1985; 55: 199-211).

From the aforementioned facts, it is obvious that you need to get investigated further to elucidate the underlying cause.
Best wishes!

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