Sudden Increase in Neutrophils level

[AAli]

Hi,

In my yesterday's CBC my ALC decreased from 97% to 60% (234 -158) while neutrophils suddenly raised to 25% from 2 % (raised to 60).

can any one explain is this any specific trend or my CLL is transforming into any other form?

regards

[johnl]

I've had something similar from time to time over 15 yrs W&W, but it was usually because of an infection or trauma (hernia) and came back down next test. I wonder tho if these blood test just don't get screwed up once in a while.

john

[AussieNeil Administrator]

First off, please totally ignore percentages and only look at absolute counts. From that, it appears your neutrophil count has gone from around 6 to 60, while your lymphocyte count has dropped significantly. (Good news!) However, I suspect as John mentioned, that your blood test result is in error and what has happened is that the automatic testing discrimination between lymphocytes and neutrophils is out of calibration, (or perhaps your CLL cells are slightly smaller than usual), so that many of your lymphocytes are being miscounted as neutrophils. If that's the case, it still looks like your lymphocyte count has dropped slightly.

Was the same test laboratory used?

I'd ask for a manual count to check, or try another pathology laboratory next blood test.

Neil

[AAli in reply to AussieNeil]

Hi Neil,

You are right, I repeated test from another lab and lymphocytes didn't decrease at all and it is following same pattern as pee previous results.

[MsLockYourPosts Passed Volunteer]

One day, while checking my labs prior to my appointment with my hematologist, the whole business of absolute counts vs percents suddenly became clear. The percents have to add up to 100%, so if, for example, the % of lymphocytes goes up, something else has to go down - usually the neutrophils will go down most noticeably. The other two percents just bounce around a little here and there. If the lymphocyte % then goes down the neutrophils will go up. It's a never ending balancing act. The absolute counts over time tell you more about what is actually happening. My "ah ha" moment about all of this.

[bkoffman CLL CURE Hero]

Absolute counts are all that matter and they are never percentages. Generally one count, good or bad, means little- follow the trends. Brian, volunteer medical director, CLL Society.org

[SeymourB]

It does sound to me like you had a fresh infection. I've had a similar thing, though my absolute lymphs did not go down much. But do ask your doctor.

I would also add that a manual count done by a hospital or clinic lab tech unfamiliar with blood cell malignancies may be off as well sometimes. Always be sure that the hospital knows that you have been diagnosed with CLL.

I've also had commercial lab tests in the U.S. that claimed to be manual that were way off. My hematologist just shrugged them off and sighed. I wish I could get my and the insurance company's money back! The American system can be crazy, because some insurance plans may not pay for a re-test unless the doctor waits on hold on the telephone for approval. Sometimes it takes hours!

So my own rule of thumb on CBC differentials is to not trust them much until you get 2 or 3 in a row that are similar. That might take a year for some people. That also has the effect of letting me relax a bit if something suddenly rises a bit.

[MelioraDay]

I had a very similar thing happen with my most recent CBC in November just prior to starting treatment. The automated CBC was actually completely in line with what all my previous CBC's had been. On my manual diff (which I always get later as it takes longer to do) the ANC is usually 2.5K LESS than the ANC on the automated CBC differential. This time it was more than DOUBLE at >9. I was not sick, no evidence of infection etc. So therefore the percentage of neutrophils was much higher than ever before and the percentage of lymphocytes was much lower than ever before. Obviously some kind of error. The very next day I had a BMB. Nothing other than the CLL going on and the biopsy actually showed granulocytic elements were markedly reduced and rarely seen.