Low Grade Fever

[Rhythmauthor1]

My apologies if this seems like a small issue but it’s the first time I’ve had a fever since receiving my diagnosis.

I have a low grade fever of 99.2. I had a cold last few days without a fever. Today was the first day with a fever. I have been on Watch And Wait since 2016. I have a wbc of 33.3. Lymphocytes at 88. Neutrophils at 14.0. What is the typical protocol for someone with CLL with a low grade fever? Should I start antibiotics as a preventative measure? Do I immediately rush to the doctor due to the CLL? When should I get concerned?

[AdrianUK]

If you have a low grade temp it’s probably a good idea to go same/next day to a GP (primary care doctor) to be assessed for possible antibiotics. But if it seems like a cold rather thank a probable bacterial infection they prob won’t give them to you. But they can for example listen to your chest to see if it sounds like you might be developing a chest infection.

Pulse is another good thing to keep an eye on and can be an early warning sign of infection.

Regarding those blood results I’m thinking you must be telling us about the percentages rather than the absolute number. As neutrophil count plus lymphocyte count should aprox equal the WBC (the other components are much less) and certainly your lymphocyte count can’t be more than your WBC! Equally tho the % s cant add up to more than 100%. Have a look again at the results. If you really had a neutrophil count of 14 then I’d be saying head to hospital to rule out a more serious infection!!

[Rhythmauthor1 in reply to AdrianUK]

Thank you! The results say the normal neutrophil range is 40-80.

[AussieNeil Partner Administrator in reply to Rhythmauthor1]

That's a percentage range which is useless with CLL. You need the absolute count. See my reply (coming).

Neil

[AussieNeil Partner Administrator]

Check with your specialist, but temperatures above 101F/38C need to be treated seriously, particularly if you can't keep them down with an antipyretic medication like paracetamol/Tylenol.

Given you only have a low grade fever and particularly since you have just had a cold, you should see your PCP/GP to see if your lungs, ears, etc are clear and you don't have a secondary infection requiring antibiotics.

With respect to your blood counts, the 88 and 14 must be percentages of your total WBC. Here you appear to have entered a number incorrectly, as 88+14 =102. They should add to a bit under 100 to allow for the percentages of the four other white cell counts.

With CLL, forget percentages, only using them to calculate absolute counts. Your absolute neutrophil count should be safely above 1.0 to ensure you aren't at risk of febrile neutropenia. 14%×33.3=4.66, so you should be fine. Be aware of the symptoms of febrile neutropenia and if you are at risk, go immediately to Emergency/A&E. Let the medical staff know you are immune compromised, your symptoms and your concern that you may have febrile neutropenia. Prompt IV antibiotics may be required.

There's more about febrile neutropenia in this post: healthunlocked.com/cllsuppo...

Neil

[Rhythmauthor1 in reply to AussieNeil]

Thank you, Neil. I appreciate your expertise. I’ll see about getting the absolute counts with my MD and go see her tomorrow. I’ll also look at the symptoms you mentioned.

[AdrianUK in reply to Rhythmauthor1]

As Neil said you can easily also calculate them so for your lymphocytes it would be 33.3*88/100=29 which is just under 30. At 30 doctor start tracking the doubling time. So in you case they would be interested to see when your count gets to 60. If that’s over a year that’s really good news and means you have a long doubling time, though it can sometime vary, so they’d be interested to see if it followed a regular pattern or not. And so if it was less than a year they’d want to see if it was just jumping up and down or following a so called “exponential growth” curve. It’s a pain for some of you in the USA that your labs sometimes only give the percentage numbers if you can’t get them from the lab each time you could create a simple spreadsheet to calculate them for you or use the maths myself and Neil have demonstrated.

[Rhythmauthor1 in reply to AdrianUK]

Thank you, Adrian - very helpful

[dmmck]

My doctor says to come in or call in if I have a fever of 100.2 or higher.