Input requested re: high lymphocyte, low ANC experience?

[lou7203]

Hi - Thanks in advance for reading my post. I had my routine CBC performed and my WBC came in low @ 3.3. The differential shows my lymphocyte count at 48.3%, my lymphocyte by thousands at 1.6, neutrophils segmented at at 40.2 and my ANC at 1.3. The NP at the doctor's office told me it is most likely a form of blood cancer or an autoimmune disorder and to see the hematologist? I had an appointment scheduled with a hematologist, but now it may be cancelled/postponed due to an incoming snow storm. In the interim, I've googled my numbers and I'm incredibly anxious.

The other lab results are coming in the normal range - my esosioonphil count is 1.2, my monocyte count is 9.1%, basophil count is 1.2, MCHC, etc. My hemoglobin is at 14, platelets at 262 (usually hover around 270s), HCT is 41.1, my RBC is 4.28. All my liver functions /CMP results are normal.

Historically, my WBC always hangs in the lower "normal range" of 4.1 - 4.8. I usually fall in the low normal end of RBC as well.I am actually feeling well - no symptoms of anything.

I was actually doing ok as I stayed off Dr. Google but with the impending cancellation/rescheduling I feel I've lost some of my rational reasoning.

Thank you again for any insight or questions I should be asking or thinking about.

[PlanetaryKim]

HI Lou. You definitely want to a doctor to answer this of course, as I know you will be doing. But all I see right off the bat is that your lymphocytes are at low end of normal and your neutrophils are below normal, which together explain your low WBC. WBC is a cummulative value of several different types of white blood cells, but primarily lymphocytes and neutrophils - so if they are both low, your WBC will also be low.

To me, nothing here says CLL or even blood cancer. But I'm not a doctor! Your other values seem to be in the normal range. Neutrophils can be low for any number of reasons. Are you fighting an infection?

Also, the % are not useful numbers for anything. The only ones to pay attention to are "absolute" counts.

Good luck with the doctor visit! I'm sure you will get some answers or useful insights.

kim

[lou7203 in reply to PlanetaryKim]

Hi, Kim. Thanks so much for your response and kind reply, I really appreciate it.

I don't really think I am fighting anything, or at least I didn't think so. Now I'm overanalyzing any sneeze or sniffle. I really don't understand why the NP just stated the diagnosis she did, it's incredibly frustrating and anxiety provoking. And looking on the internet (even though I swore I wouldn't) just created more questions and self-diagnosing.

Thank you for the clarification on the %'s - I was very confused by the % and then the "segmented by thousands" figures. Especially when the % indicates its high (e.g., on the lymphocyte) side but the segmented thousands numbers are normal.

I hope you are feeling well and wish you the absolute best. Take care,

Lou

[PlanetaryKim in reply to lou7203]

Well, I was going by your lymphocytes figure of 1.6. At my lab, the normal range (reference range) for lymphocytes is 1.0-4.0 (x10*9/L). So assuming we are talking about the same units, your lymphocytes are not high.

And with your ANC (Absolute Neutrophil Count) at 1.3, that puts you somewhat below normal, which is 2.0-7.5 at my lab. But your lab results should also include the reference ranges because those will vary somewhat from lab to lab.

Unless I am reading something wrong, there is no evidence of CLL or any other blood cancer in those two numbers.

[lou7203 in reply to PlanetaryKim]

Hi, Kim. Yes, the reference for the lymphocyte by thousands here (normal) states .8- 4.0 (mine was 1.6). The lymphocyte count % is what showed high I guess, at 48.3% - so my lab showed a normal by thousand k/uL but the % number was high and out of the range (range 13- 40% here).? My neutrophil segment % was at 40% on the low end (the lab normal is 45-75%) and my ANC count of 1.3 fell below the lab range of 1.8-7.9 here. So the lymphocyte thousand is in the normal range, but the lymphocyte count % is high, which really confused me.

Thank you again for your thoughtful response and chatting with me. I really am grateful. Be well and take care.

Lou

[PlanetaryKim in reply to lou7203]

The %'s really should be ignored. Lymphocyte % in your case is high simply because you neutrophils are low. And so proportionally your lymphocytes account for a higher % of total white blood cells in the mix. but not because they are high, just because neutrophils are low. it's best to ignore the %'s altogether and only look at the absolute numbers for this reason.

[lou7203 in reply to PlanetaryKim]

Thank you again, Kim. You really made this so much more understandable.

[MsLockYourPosts Passed Volunteer in reply to PlanetaryKim]

My "ah ha" moment regarding percents came one day when a little voice in my definitely not math oriented brain said that the percents will always add up to 100%. So, as Kim said, if one goes up, another must come down.

[lou7203 in reply to MsLockYourPosts]

Yes, I can relate. I am not a math person at all. Writing, reading, etc. is my jam. The math always throws me and makes me feel inept. lol Thanks for making me smile.

[Needsunshine]

You shouldn't take one result and read too much into it. Your wbc and anc are low ..alc is normal does not present in anyway cll but there could be many reasons for a low anc, wbc. If there not consistent results (several over a period of time) but a one time result it's not something you can read much into. Was there a report on the lab from a pathologist indicating any flags? For your DR to say it's most likely something based on one result with no other information is not very responsible unless the DR has other information.

[lou7203 in reply to Needsunshine]

Hi, thanks for your response. No, there was no report from the lab or special notation from the pathologist indicating any flags at all. It was the nurse practitioner who gave me the two potential outcomes based upon the above numbers and the recommendation to see a hematologist, which is why I was so taken by surprise. She did not have any other information.

I appreciate you sharing your thoughts and experience, and for you both in taking the time to clarify a few things for me. I'm hoping the hematologist visit will go well and will shed some more light on things. Have a nice evening and take care.

Lou

[MsLockYourPosts Passed Volunteer in reply to lou7203]

The NP should not have suggested a diagnosis, especially if she was basing it on one set of labs. Suggestion a hematologist for you to get more input wouldn't be out of line, but your low neutrophils could be anything, including lab error.

I hope you are able to keep your appointment. Waiting for input is hard, but please stay away from Dr. Google! You will find 20 or more reasons that your death is imminent, none of which apply. Been there. My doctor reminds me that I'm missing one thing when reading up on google - medical school.

Keep us posted.

[lou7203 in reply to MsLockYourPosts]

Thanks so much and I am going to stay off the internet research. It's overwhelming. I love your medical school comment. I am going to go back to that and with your permission, use it.

[MsLockYourPosts Passed Volunteer in reply to lou7203]

Use it and share it! We all need that reminder sometimes.

[AussieNeil Partner Administrator in reply to lou7203]

Lou

I have just caught up with this post and the very good replies you have had. PlanetaryKim has in my opinion correctly worked out what has happened. As the longest serving active admin for this community, where I have seen this error made by patients and even medicos many times before, as well as personally approaching around 200 blood tests, where living with neutropenia has my major health challenge for over 11 years, what I believe has happened is that your NP has made a common, but fundamental error in focusing on your percentage differentials, Even GPs/PCPs commonly look at the percentage differentials because the general population has white cell counts that stay within the reference ranges. However, what is important are the ABSOLUTE counts. The only thing that is unusual in your results is that you were stage 2 neutropenic in ONE blood test (i.e. you have a neutrophil count between 1.0 and 1.5). There are NONE of the common signs in your blood counts that imply you have leukaemia and I expect you have no other typical symptoms of leukaemia. Your lymphocytes, platelets and haemoglobin are all nicely in the reference ranges.

I understood that the general medical practice when such a result as yours occurred, was to schedule a repeat blood test a month later and if that was again low, to check for any trend with more frequent testing before referring you to a haematologist for an investigation into your low neutrophil counts. Unless your NP is aware of similar past results in your history. I would expect your next blood test to show a normal neutrophil count - along with everything else normal! From what you have shared, your haematologist consult will be a non-event with the possible focus on what could be causing your neutropenia, NOT possible leukaemia!

Please let us know how you get on.

Neil

[lou7203 in reply to AussieNeil]

Thank you so much for responding Neil. The information shared is incredibly valuable and puts things in a better perspective for me, as well as gives me some foundation when talking with the specialist.

I will definitely update once I get to the doctor. Fingers are crossed that this snow system is not as bad as originally thought and the visit won't need to be rescheduled.

I just wanted to thank everyone again. This community is incredibly gracious and open in helping and educating others. Your positive and caring responses have made the stress more bearable. Wishing everyone the very best,

Lou

[Smakwater]

lou7203,

Assuming that you are diagnosed with CLL and unless I missed it somehow my questions are:

Do you have any co-existing conditions?

Are you being treated for any condition or taking any type of medication?

JM

[lou7203]

Hi, I have vestibular migraine that was diagnosed a few years ago from two neurologists, and had full workups done at that time for lupus, etc. And no, I am not taking any medication at all, besides my multivitamins and supplements. I should note that I haven't been diagnosed with anything right now - my WBC came in low and the NP told me I needed to see a hematologist, based on my numbers above. I was trying to find additional information/guidance re: the numbers and questions to ask/think about when meeting with the specialist. Thanks.

[lou7203]

Hi, I just wanted to follow-up and share that you all were correct. The hematologist confirmed what was stated above in your various responses. Thank you again for sharing your time and thoughts. It helped me be much more prepared and ask the right questions, etc. Wishing you all health and happiness. With gratitude,

Lou