Low reticulocyte and lymphocyte - need help

[stilltired]

Thanks in advance...

My medical history consists of Celiac Disease (november 2009) and a pacemaker for bradycardia/dysautonomia (oct 2008) caused by untreated Celiac nerve damage. I am also 24 years old and male.

Over the last year, my WBC has always been between 4-6 (normal 4-11), absolute lymphocytes have been chronicaly low at 700-1200 (normal 1500-4000) and my RBC has been between 3.5-4.6 (normal 4.6 - 6.0).

During fall 2009 my retic count was also checked and my absolute retic was at 14 (ref range 25-80). I was sent to a hematologist to get a bone marrow biopsy and one month before my appointment I was diagnosed with Celiac Disease. The hematologist retested my blood before the BMB and my RBC came back at 4.5 (normal 4.6 - 6.0) and my retic dropped to 13 (normal 25-80). She told me that the retic is not concerning enough to her for a BMB because my RBC is normal and she said Celiac may be the cause and sent me on my way.

Since my Celiac diagnosis my RBC has stayed around 4.2 - 4.5 consistantly and my WBC has stayed around 4-6, with absolute lymphocytes still hanging low around 1000. I recently had another full checkup and here were my results:

RBC: 4.4 (ref range 4.6 - 5.6)
Hemoglobin (HGB): 135 (range 130 - 170)
Hematocrit (HCT): 38.5 (range 39 - 50)
PLT: 190 (range 140-400)

ABS Retic: 15 (range 25 - 85)

WBC: 5.76 (range 4.5 - 11)
ABS Neutrophils: 4.19 (ref range 2.0 - 6.3)
ABS Lymphocytes: 0.65 (ref range 1.5 - 3.5)
ABS Monocytes: 0.57 (ref range 0.2 - 0.8)
ABS Eosinophils: 0.31 (ref range 0.04 - 0.4)
ABS Basophils: 0.03 (ref range 0.00 - 0.1)

B12: 276 (range 220 - 1000)
Ferritin: 71 (range 50-80=reduced, >80=normal)


Also during my checkup I had a full body ultrasound to check for lymph nodes and some were found in my neck (largest 1.8cm x 0.8cm) and armpit (largest 2.5cm x 0.8cm). The lymph nodes were large, but appeared benign. The only worrisome looking lump was a small 8mm ill defined hypoechoic nodule was found on my thyroid and is being followed in 6 months intervals. My thyroid, vitamin and other panels were checked, which were all normal.

Does anybody know why my retic would remain low, lymphocytes always low (now worse) with my RBC and WBC always remaining borderline low to low normal?

My GP is confused at my results, but is unsure whether another trip to the hematologist is warranted or not. I feel like a BMB is needed even though I am not anemic. I feel run down all the time and I feel like the retic has a reference range for a reason. Any help is appreciated.

Thanks.

[Marlene]

Your story sounded familiar. Did you post this thread under the name "alevoy18"? http://forums.marrowforums.org/showthread.php?t=1640

[asurisuk]

hi, i also saw the contribution from alevoy18, that was made about a year ago.

My picture is exactly the same as alevoys and stilltireds. All cell counts hovering at the borderline level - RBC and WBC dropping under normal range from time to time. Its been like this for 10 years since taking some very toxic chinese medicine (lei gong teng).

Its because I have long suspected some kind of bone marrow problem that I asked for a reticulocyte count and it came back as 20.

Like you, I am concerned, and I find it really frustrating that my GP isn't more so. To me, its a system thats limping along....and how long can it do that for?

I also want a bone marrow biopsy, although I'm scared it might be painful, because I want to know as soon as poss, not when I'm bleeding from my nose, mouth and intestines, which is when my GP seems to think it would be time to intervene - they appear to do everything on the presentation of extreme symptoms.

Anyway, I have scoured the internet trying to find out information about how low a low reticulocyte count is. I mean how low can it go. How low does it go before the doc gets concerned. I've read of some very low numbers here....6....2.5...

I've also got these red-purplish spots - they're called petechiae and are pin point haemorrages and are a symptom of aplastic anemia which i think is what i've got.

i'm 45, and i'm really scared that i'm going to go under within 5-10 years.

[triumphe64]

Your retic only needs to work hard enough to maintain your hemoglobin. The extreme cases where it work harder would be newborns who no longer get blood from their mothers or someone going to high altitude. If your Hg is normal, then don't worry about the retic count. If it is low and your Hg is also low then you can worry some. Think of it as a dam that you want to keep at a certain level.

[asurisuk]

i am a complete novice here, don't get me wrong, and i've yet to see my doc again to discuss all this, but I see a low retic count as an indicator of bone marrow disease. The fact that the Hg remains passable does not mean that the disease does not exist, simply that it is still managing to hang on in there. But it does suggest a vulnerability. My health is affected by my environment, which is why it is important to know at the very earliest stage, so that i can get to a place where the obvious weakness is not made worse.