This is my first post here so please be gentle with me!
Please can you help?
I have today received a copy of my latest blood test results. There is plenty of information on the results sheet (including a WBC of 41.9!), but I can't see any mention of the number of lymphocytes in my total white cell count. There are figures relating to other components (neutrophils, eosinophils and basophils) but no reference to lymphocytes.
Is this a normal format for FBC results or am I missing an important bit of information....?
Thanks, folks!
Deb.
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debs24
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Can you type up all the numbers you have got together with the units.
Also can I ask for how you got the results e.g. was it just a routine test or did you have any other symptoms that you thought might be relevant. Also have you any previous results to compare with.
Welcome to the site. I'm sure people here will be gentle with you!
As Ernest has said, it would be helpful to know what your other numbers are, and more importantly, do you have previous counts to compare with (specially WBC, neutrophils, Haemoglobin, platelets.).
If you subtract your neutrophils from your WBC, you will get the approximate lymphocyte count. WBC is lymphocytes plus neutrophils (plus a few other sorts of white cells that rarely add up to much).
My WBC has been wavering around the 270 for the last 6 months, so 41.9 is very small compared to that. But as I expect you know, it's not the lymphocyte counts themselves that are so significant, it's the changes in those counts, and the trends of those changes. They used to say that if the lymphocyte count doubled in less than 6 months (and was over 30), it was an indication of the disease progressing and needing closer attention, possibly treatment. But even that seems to be a debatable point these days. A quick doubling needs close attention - yes, but not necessarily treatment.
Are your doctors happy with your results at the moment?
Wishing you all the best,
Paula
P.S. You've probably been to this link already, but there's a lot of useful stuff here.
Here is a little more information, as requested...
I was first diagnosed with a high white cell count last Sept during a routine health check with my GP...cue a series of further tests and a referral to a haematology team at a local(ish) hospital.
My white cell count in Sept was 29.6 and remained around this figure when I was tested at the end of December. However, my WBC count has increased to 41.9 at my blood test in April...
Unfortunately, due to some poor advice from my GP's surgery, I was initially referred to a hospital in a nearby town (I assume I was asked to go there for tests as the waiting times were shorter than at my local hospital). I have since been re-referred to my local hospital where I had to start the testing cycle again as the two hospitals fall under different health authorities and do not share information!
I do have a copy of my blood test results from the first hospital but I'm not sure how useful they will be when comparing them to my latest results from my local hospital...😕
Anyway, here are some of the results shown on my latest blood test;
White cell count - 41.9 10*9/L
Haemoglobin - 151g/L
Platelets - 232 10*9/L
Red cell count - 5.42 10*12/L
Neutrophils Absolute - 8.7 10*9/L
Neutrophils % - 20.7%
Eosinophils Absolute - 0.3 10*9/L
Eosinophils % - 0.7%
Basophils Absolute - 0.1 10*9/L
Basophils % - 0.3%
There is no reference to lymphocytes on my results, as either a count or a percentage, which I find rather odd as I understood the lymphocytes were the key measure to monitor with CLL.....but as I'm pretty much a newbie to all this I'm fully prepared to be wrong here!
Any information or advice provided will be most gratefully received.
I am currently soaking up the various insights given on this site (a fantastic, supportive resource!) but am well aware that there is a LOT to learn!
Deb - It's very strange that your report does not show an absolute lymphocyte count or a percent. I would assume that this is an error in reporting.
Don't apologize for being new at all of this. I'm sure it won't take you long to develop a good knowledge base. Then it will be up to you to decide how deeply you want to get into the complex scientific reports coming out all of the time. I am not terribly scientifically minded, so I skim through most of those in the interest of being somewhat up to date, knowing that there are others here who can explain what I don't understand, if I ever need information about something specific.
Thanks for telling us more. As Pat says, it does seem strange that there’s no mention of actual Lymphocytes, in your test results. As you know, they are the best thing to monitor rather than the total white cell count (WBC). However, I think it might be possible to work them out, from the figures you’ve got. . There are some very clever folk on this site who might be able to do the calculation for you. I don’t see Monocytes on your list though, and they are also part of the white cell count. (Lymphocytes, Neutrophils, Eosinophils, Basophils and Monocytes are all white blood cells).
At 8.7, your neutrophils are on the high side, so it could be partly an infection that has caused the rise in WBC from 29.6 to 41.9.
It’s good to see that your Haemoglobin levels are good and high, and platelets are fine.
Anyway, as you know, it’s not all about numbers. More important is how you feel. Do you have excessive sweats? Are you aware of any enlarged nodes, or an enlarged spleen or liver? Do you get more infections than before? I’m sure the doctors will be asking you about those things. You say you were diagnosed during a routine health check with your GP, so I guess you weren’t aware of any problems at that time.
As you say, so much to learn. There are always people here who are happy to answer your questions, as best they can. But take your time… As Pat says, you may decide not to go too deeply into the scientific stuff – or not at first. Just concentrate on keeping your general health as good as you can, and enjoying life.
Oh...this is fantastic! Useful, considered replies from people who've "been there and got the t shirt"! I can't tell you how reassuring it is to hear from fellow CLLers....!
In response to your latest post, I can confirm that there is no mention of monocytes on my recent blood test results either....strange?!
I see that you have noted my high neutrophils (8.7) and mention that an infection could be the cause of an increase (they were 7.2 at my December blood test but, as I mentioned, that blood test was done at a different hospital/lab). Could anything else be responsible for an increase in neutrophils? Would an infection cause an increase in lymphocytes too? (My head is spinning!!)
On the plus side I have no other " CLL issues" - no sweats, no swollen nodes, no enlarged liver/spleen (that I know of!😶). I am 52, work full time and am fairly active (my husband is a keen triathlete and I'm his main supporter! We spend lots of time outdoors at various races/events where I cover quite a few miles as spectator/supporter/bag carrier/coach/etc. I often tell hubby its harder work being a spectator than a competitor... he ignores me!).
I'm toying with the idea of contacting my hospital to ask about my "missing" lymphocyte and monocyte counts, but maybe I'll heed your suggestion of not delving too deeply into the technical side of things just yet....I'm sure there will be plenty of time for that!
Well...the sun is shining and work beckons... life goes on, so I'll head out with a smile on my face (makes the neighbours wonder what I've been up to!😉).
Thanks again for your comments - they are very much appreciated!
Deb, it is most unusual that your lymphocytes have been omitted. Monocytes are far less important and are generally very low in any case, so usually we can safely ignore them. On that basis, there's enough information from what you've provided to calculate your ALC
1) Using Absolutes:
As Paula says, your ALC is your WBC - (all other white cell counts)
41.9 - 8.7 - 0.3 - 0.1, which gives an ALC of 33.2
1) Using Percentages:
(100 - 20.7 - 0.7 - 0.3) x 41.9 which is
78.3% of 41.9
or an ALC of 32.8
That small difference would be due to rounding errors in the percentages and the missing monocytes. Anyway, the important news is that your ALC is 33, which is just above the ALC level of 30 after which CLL specialists start taking an interest in doubling times.
Your highish neutrophil count could be due to a past infection and that could also be pushing up your ALC. It's not that much out of the normal range, which is roughly between 1.5 and 7.5 depending on your testing laboratory.
I can't see anything there to be concerned about. Your haemoglobin and platelets are also at enviably healthy levels - perhaps you could spare me some?
Thank you so much for the email and the benefit of your wisdom!
I'm a little concerned about my ALC - far too high/increased too much in a short time! - but I guess there's little I can do until my next haemo appointment in early July. I'll have to shove it to the back of my mind (if possible!) and carry on regardless...
Thanks again for your help....and if I could spare any of my blood (the good bit!) I'd be more than happy to share! 😊
You may well find that your ALC has gone down in your next test. It can jump around considerably, which is why specialists look for overall trends. Also, remember that your neutrophils could have been much lower back in December, so your ALC may have gone up only slightly.
The important thing is that you are otherwise fine and we all hope that it stays that way for you.
Thanks for your supportive comments - they do make me feel much better! ☺
I did manage to get my ALC from the first blood test I had back in December (from a different hospital to the one that provided my latest results) - it was 19.9 so, sadly, it does look as though my ALC has increased considerably between then and April (now calculated at 33) 😕
However, as you say, maybe my figures will look a little better on my next test in July....fingers crossed!
Anyway, it's time to go home from work now and the sun is still shining, so I'm going to put thoughts of CLL as far back in my mind as I can and I'm off to enjoy the weekend.
Everyone seems to have done a really good job of answering your questions ( while I have to admit being out in the garden). I can recommend bookmarking Paula's posts to read when you have the right moment.
One minor point if you read about lymphocyte doubling time, there is an extra rule that sometimes does not get mentioned that you only consider that once over a level of at least about 30, so I wouldn't worry about your rise since September.
In the longer term if you care to indicate very roughly where you live sometime (suggest no more than county) then others may be able to recomend one of the big city hospitals where there is possibility to meet those clinicians that do research. Just something to think about, and no need to rush into at the moment.
Lovely to hear from you...hope you haven't had to work too hard in your garden today!
Thanks for your wise words on lymphocyte doubling time. I had got myself a bit worried today but your sensible reminder (about this only being an issue once ALC exceeds 30) has calmed my worries a little ☺ - thank you.
I live near Manchester, in answer to your earlier question. The doctor at my hospital suggested that if/when the time comes for me to start treatment, there may be opportunities for me to be treated locally or referred to The Christie, especially if there are any appropriate clinical trials available.
I know the Christie is a highly regarded hospital but I was under the impression that I could only access treatment there if I was referred by my own doc/hospital.
I would certainly be interested in hearing any experiences from fellow CLLers who have been more proactive in arranging their own treatment (Go CLLers!!!)
Thanks again for all your reassurance and kind thoughts.
No worries about the gardening. Unlike a lot of other things you can just stop, drink tea and admire the view when you have had enough.
For the Christie Hospital, suggest ask that as a question here on HU how other people in the area got referred. In my area whilst I had been to the local hospital, I just asked my GP for a referral (after I thought I was ALC doubling) to the big city hospital doing research. I was really pleased when I got there, that amongst other things they asked me for some extra blood samples to help with the research (I still chuckle at that how I might have even thought of saying no).
Probably worth getting as up to speed as you can on things like prognostic markers before you go to the Christie, so you have a good set of questions (CLL probably splits into three distinct groups of patients depending on how fast, or slow it develops). I'd perhaps ask the local hospital those kind of questions first, if you have your next appointment booked with them.
A quick bit of googling for the Chistie, CLL, and HU reveals e.g.
Absolutely no need for any apology...you have been so helpful with your replies!
But, as you know, I've received some extremely useful advice and pointers from yourself and fellow CLLers on this site, and I'm now on a mission to get myself referred to a local specialist, starting with an appointment to see my GP to get the ball rolling asap.
Thanks for all your comments and suggestions - they are all very much appreciated! ☺
I’m so glad you’ve found our replies helpful, Deb. I loved the thought of you heading out this morning with a smile on your face – making the neighbours wonder…
Great to hear that you’re still able to work full time, and you keep active. Also great that you have no other “CLL issues”. I didn’t either, for many years, (except for tiredness).
I think you’re right not to bother contacting the hospital about your missing ALC (Lymphocyte) and Monocyte counts. You could always ask next time you’re there. (Are you on 3 monthly checkups?)
I just checked out my own Monocytes over the last 5 years - they have ranged between 0.0 and 2.9. (And mostly waver around 1.0) . The 2.9 was a one-off high – don’t know what happened there. Anyway, those sorts of numbers (and the even lower numbers of Eosinophils and Basophils), don’t make up much of the total WBC. It’s the Neutrophils that make more difference, and you have a number for them, so can work out approx ALC.
You ask about other things (apart from infections) causing high Neutrophils… Well, I’m not an expert, but possibly inflammation would do that (eg arthriits and irritable bowels). And exercise can raise Neut levels, especially rigorous exercise. I think certain Infections may cause raised Lymphocytes (as well as raised Neutrophils), but I don’t know to what extent.
I’m rather out of my depth here, and my head is spinning too. But it’s been interesting to think about these things… Hopefully someone else will be able to answer these questions better than me.
As you say, life goes on, and the sun is shining, Enjoy the sunshine (but don’t forget to cover up – large brimmed sunhats become part of life for CLLers).
Best wishes,
Paula
P.S. Now I've posted this, I see that Neil has replied and done the sums for your ALC.
Thanks again for your interesting and informative post.
As you've seen, Neil has been in touch to give me a figure for my lymphocytes (which I'm very grateful for, even though my ALC isn't a great figure, if I'm honest!) so at least I'm now fully up-to-speed on what's circulating through my body!
Anyway...there's only a few hours of work left and the weekend will be here - hooray!
Hope you enjoy your weekend and let's hope the sun shines on all of us (for a while...as long as we have sunscreen...and we're wearing our big hats...😉).
Hi just to say about which hospital is best for you. Seeing a specialist especially when first diagnosed is very helpful. You may not need to see them again until treatment is necessary and that may well be in years time. Best wishes
As I've already been diagnosed with CLL I really thought my treatment path was pretty much dictated to me - i.e. the doctor I saw at my local hospital is the same person who will lead me through the rest of the CLL maze!
I am a bit naive/inexperienced when it comes to the world of healthcare but is it possible for me to ask to be referred/seen by a CLL specialist (I'm assuming the doctor I've already seen at my local hospital is not a CLL specialist but I've only spoken to her for 15 minutes and, to be honest, I wasn't really aware of what to ask her!)?
As I mentioned, I live fairly close to the Christie in Manchester where I guess I could locate a CLL specialist - I'm just not sure how to access their services!
Any pointers/advice would be, as always, much appreciated.
This is really a separate question and you'll get a much better response if you ask it as such, rather than at the bottom of this post. You'll also help others who come along later with exactly the same question, as they will be able to much more easily search out your question and immediately find helpful answers.
The Mayo Clinic in the USA published a study a year or so ago that showed that the survival time of CLL patients was a couple of years longer if they went to a CLL specialist, so it is well worth the effort of searching one out.
That's a good suggestion, Neil - thanks. I will post my question about accessing CLL specialists...already looking forward to the responses I'm sure to get!
Hi I live in the UK and was initially sent to my local hospital, which I still attend but asked to be seen by a specialist on the Cll society list. The hospital was happy to do this and for me it was the right decision. Do not be put off and do not be frightened to ask. Best wishes
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