Help with cbc

[craig p]

Hello everyone, I am new to this forum and was looking for opinions on my most recent cbc. For about the last year my wbc counts have been low. No other symptoms or issues that I recognize. I am male, 46, overall reasonable health. I have atrial fibrillation and take metoprolol once a day (50mg).

Any thoughts or info would be greatly appreciated. My pcp wants me to see a hematologist again. I saw him about a year ago and he wanted to do a biopsy but my counts began to rise to the lower end. My pcp said I could wait 3 more months and recheck the cbc. Here is the result from last week. Sorry the formatting took a hit.

Anyone have counts like these? What was the diagnosis? Thank you very much!

WHITE BLOOD CELL COUNT 2.5 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 4.70 4.20-5.80 Million/uL
HEMOGLOBIN 14.9 13.2-17.1 g/dL
HEMATOCRIT 44.4 38.5-50.0 %
MCV 94.5 80.0-100.0 fL
MCH 31.8 27.0-33.0 pg
MCHC 33.6 32.0-36.0 g/dL
RDW 14.6 11.0-15.0 %
PLATELET COUNT 152 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 1115 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 788 850-3900 cells/uL
ABSOLUTE MONOCYTES 455 200-950 cells/uL
ABSOLUTE EOSINOPHILS 103 15-500 cells/uL
ABSOLUTE BASOPHILS 40 0-200 cells/uL
NEUTROPHILS 44.6 %
LYMPHOCYTES 31.5 %
MONOCYTES 18.2 %
EOSINOPHILS 4.1 %
BASOPHILS 1.6 %

[bailie]

I would suggest seeing a hematologist. It wouldn't hurt. The more knowledge you have about your own situation the better you will be able to act if necessary.

[Whizbang]

Hey Craig,

I'm going to be 46 next week, and recently my hemo put me on metoprolol once a day (25mg)... (she didn't like me walking around BP of 140/85)

There are many reasons why you could have low WBC's, and you really should see your Hemo/onclologist for the low WBC counts...

There are many tests they can do before a BMB (bone marrow biopsy), to check your blood for infections, and possible causes of low WBC's...

Ultimately a BMB may be necessary to rule out some of the worst possiblilities...

Best of luck to you, and keep us informed on your progress...

[Neil Cuadra]

Craig,

With 44.6% neutrophils and a WBC of 2.5 you'd likely be classified as "low normal" or "mildly neutropenic" (meaning you have a mildly elevated risk of infection). Your absolute neutrophil count (ANC) is 44.6 x 2.5 x 1000, which comes out to 1115 (higher is better). Having an ANC above 1500 would be safer. Hematologists don't agree on when to get serious about diagnosis and treatment, but an ANC below 1000 would definitely be too low, and you're close to that range.

Forum tip: If you type or paste text into a forum post using spaces to line up the columns, then select the text and click the icon in the editing toolbar, you'll get CODE tags around the text, and that will make it keep the spacing you used. Here's how you can make it come out:

WHITE BLOOD CELL COUNT  2.5     3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT    4.70    4.20-5.80 Million/uL
HEMOGLOBIN              14.9    13.2-17.1 g/dL
HEMATOCRIT              44.4    38.5-50.0 %
MCV                     94.5    80.0-100.0 fL
MCH                     31.8    27.0-33.0 pg
MCHC                    33.6    32.0-36.0 g/dL
RDW                     14.6    11.0-15.0 %
PLATELET COUNT          152     140-400 Thousand/uL
ABSOLUTE NEUTROPHILS    1115    1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES    788     850-3900 cells/uL
ABSOLUTE MONOCYTES      455     200-950 cells/uL
ABSOLUTE EOSINOPHILS    103     15-500 cells/uL
ABSOLUTE BASOPHILS      40      0-200 cells/uL
NEUTROPHILS             44.6%
LYMPHOCYTES             31.5%
MONOCYTES               18.2%
EOSINOPHILS             4.1%
BASOPHILS               1.6%

[KMac]

Hi Craig,

You can certainly feel comfortable with the rest of your counts outside the WBC, as they look great!

As Neil said, an ANC below 1000 is a cause for concern. That said, my ANC usually runs about 650 (with a WBC of 1.5), and I seldom get sick (details of my condition on my signature below). I feel well and live a fairly normal life.

I sure understand your concern though. Psychologically it is difficult being neutropenic, wondering why, and wondering if it will one day cause a problem. In my case, I know my cause is aplastic anemia, but still we don't really know why my other counts have recovered so much more after treatment than my WBC/ANC.

Also, I know of nothing that can be done to provide a durable boost to my low ANC, outside of something drastic (more ATG, BMT, or medical trials). I was hoping to get my case reviewed at NIH, but Dr. Young (pioneering doctor in aplastic anemia treatment) reviewed my records and determined I was doing well enough not to warrant an appointment. I feel if he is not concerned enough with my ANC to see me, that is probably a good sign!

I more-or-less successfully responded to my treatment about 18 months ago, but this WBC issue has been basically the same since then, I am at about the same place I was over a year ago when I wrote the post (if you are curious to see more detail on my WBC questions):
"AA & white blood cells - Any experience with alternative methods to raise WBC?"

I'd wager you don't have aplastic anemia, especially with the percentage of your WBC that is ANC. At diagnosis my WBC was about the same as yours, but my ANC was only about 10% of the total. I think it is a good sign that your ANC is as high as it is relatively speaking.

I know people without any diagnosed blood disorders who have ran low in their WBCs for a year or more, and then the counts just went back to normal as mysteriously as they had fallen.

As a layperson, it strikes me that of the 3 main bloodlines (red, platelets, and whites), the whites are the most complex, and the most mysterious to hematologists; even in this age of ever-improving understanding and treatment. I know of people with three times the ANC I have who get sick three times more often than I do. Over Xmas most of my relatives (all without blood disorders) were sick, not me with an ANC of 650. Late last year I stopped 'unplanning' events with friends and family when one of their kids got sick. I still am very careful, but no longer to the point of quarantining myself away from others.

I hope this post provides you more comfort than worry, in that:

1) Your counts look quite good, relatively speaking, and most likely your currently low WBC will resolve on its own (although it'd certainly be good to see a hematologist if it continues).

2) Even with a low WBC and a blood disorder, a person can still have a good quality of life.

[KMac]

Hi again Craig,

One other thought, I noticed on WebMD that a low WBC is listed as a rare side effect of the medication you are on:

http://www.webmd.com/drugs/drug-8814...l&pagenumber=6

And also, they list low platelets as another potential side effect. I noticed while your platelets are fine, they are on the lower end of normal, as compared to your red blood which is well into the normal range.

I wonder if that would be worth bringing up to the doctors, with the idea of perhaps trying a substitute?

It seems there are many medications with lowered blood counts as an uncommon but notable side effect.

[craig p]

Thank you KMac, Neil, Whizbang and bailie, how did we ever get along without the internet and forums like these?

KMac, my platelets were below the range on 2 previous blood tests so there's a little history there. I am definitely going to follow up with my pcp and bring it up to the hematologist when i see him again. Reading that list of side effects I feel like I have most of them.

The hematologist wants to do a bone marrow biopsy and I was hoping to avoid it for several reasons... not the least of which is I saw the procedure on a few youtube videos and it looked harsh. I could give blood and take needles in the arm all day long, doesn't bother me... needle in the pelvis, yikes. Still, I feel humbled and foolish knowing that many on this site have endured the procedure or worse.

Many thanks to everyone for taking the time to reply.
Craig

[Whizbang]

I had another BMB/BMA today, and it was only a 3/10 pain...

Believe me many of us here would gladly go through 10 BMB/BMA's just to rule out that we have / or don't have (what we've had)...

Best of luck to you...

[bailie]

craig p,

I understand exactly your feeling about a BMB. It was a pleasant surprise for me after having my first one a couple of months ago. I did take a couple of Vicodin before going in however. I walked out of there with a smile on my face because it wasn't close to what I had anticipated. I felt no pain afterwards and went golfing the next day and walked six miles/18 holes over a hilly course. Never felt any pain. I will have my third one next week.

[Cheryl C]

KMac - I agree re the BMBs. They aren't as bad as you might expect. I actually look forward to having them because often MDS doesn't make you feel terribly ill so a BMB is the only way to find out if the blasts are increasing.