Confused by bloodwork

[Mend123]

Had flow cytometry saying “apparent” loss of p17 and TP53 and two subsequent FISH tests saying TP53 normal. Also a recent WBC in normal range (was previously increasing) with elevated but lower lymphocytes but now elevated monocytes and low neutrophils. What the heck?

[AussieNeil Partner Administrator]

Hi Mend123,

You haven't really provided enough information for a thorough answer, particularly with respect to your changes in your lymphocyte, monocyte and neutrophil counts. Firstly, it's important to look at your absolute counts, not percentages. Secondly, counts can bounce around significantly due to a number of factors:

- Different test labs used

- Repeatability limitations of lab test equipment (testing the same blood sample will give small differences)

- Different time of day test was done

- Infections, including subclinical ones that you aren't aware you have

- Allergic reactions (particularly impacts eosinophil counts)

- Drugs and some foods/supplements

- Exercise (this can boost neutrophil counts in particular)

With CLL, it's trends that are important, rather than becoming concerned at high or low readings due to variations caused by the above. Provided counts remain within the reference ranges, that should be of no concern (accepting that your lymphocyte count will be above the upper reference range unless you are early stage CLL or have the SLL form of CLL/SLL). Your WBC is comprised of the combined count of 5 different white blood cell types (6 if you separately count young and mature neutrophils). Your lymphocyte count on its own is comprised of CLL cells, healthy B-cells, helper and cytotoxic T-cells and NK cells, all of which can vary independently. It's not uncommon for individual white blood cell counts to temporarily drop or exceed their reference ranges.

With respect to your FISH test results, you can expect slight variations over time, which should be more clearly understood if you look at the percentages for the different markers. Remember, a sample of lymphocytes are examined and what gets included in that sample will vary, as you may have more than one CLL clone or more commonly, your CLL clone has developed sub-clones, for example, some which have lost 17p or have accrued TP53 mutations. (TP53 is located on 17p).

While the question in the post referenced below is in respect to changes during treatment, the discussion may help you understand factors behind your FISH test result changes

How do bad markers disappear?

healthunlocked.com/cllsuppo...

Neil

[Mend123 in reply to AussieNeil]

The first flow cyt (“apparent” losses of p17 and TP53 and the first FISH (normal TP53) were of the same blood draw. The second FISH was a few weeks later draw and a different lab. (Oct 25 vs nov 6 second opinion). also at that time my WBC had gone from 11 to 13. My lymphocytes from 6.1 to 7.9. Blood draw on dec 11 had WBC in normal zone (10) and lymphocyes at 6. But monocytes at 1.4 (elevated with high of 1.3) and neutrophils at 21% (low and lower than Oct 25 and Nov 6. The only change I’ve done is drink lots of green tea (since nov 6) and added turmeric and zinc to my multi vitamin regimen (since about nov 8).

[Big_Dee in reply to Mend123]

Hello Mend123

I had 4 FISH tests over 1 1/2 year period. Went from 13q deleted to 13q normal after treatment. So yes, they can change. Normally your 13q deletion will be percent then rise as time goes by, then percent will decline after treatment. Blessings.

[AussieNeil Partner Administrator in reply to Mend123]

The first results from the same blood draw are probably explainable due to the different sample of cells examined. Looking at the reports and the percentage of cells found with the different markers would probably explain the differences.

With respect to your WBC changes, reference ranges vary from lab to lab and I take it your lab uses 1.3 as the upper reference limit, so 1.4 is not really concerning. I've also had occasional raised monocyte counts, including one just over 1.4, without concern. As I mentioned before, a sub-clinical infection can cause raised counts, as can inflammation. (Most labs have monocyte upper reference limits of around 0.8 to 1.0.)

The variation in your lymphocyte count is quite normal and is actually rather stable, as well as being low for someone with a CLL/SLL diagnosis.

NEVER look at percentages of white blood cell types when you have CLL. They are dangerously misleading - just as you have probably been misled in your concern that your neutrophils are dropping. Always monitor the absolute counts, which ideally should be over 1.5. Given your WBC has increased from 11 to 13, your absolute neutrophil count could have stayed the same or even increased while your neutrophil count percentage dropped, due to the increase in your monocyte count. See: healthunlocked.com/cllsuppo... A neutrophil count of 2.73 (21% of 13) is quite adequate.

Neil

[AussieNeil Partner Administrator in reply to Mend123]

The first results from the same blood draw are probably explainable due to the different sample of cells examined. Looking at the reports and the percentage of cells found with the different markers would probably explain the differences.

With respect to your WBC changes, reference ranges vary from lab to lab and I take it your lab uses 1.3 as the upper reference limit, so 1.4 is not really concerning. I've also had occasional raised monocyte counts, including one just over 1.4, without concern. As I mentioned before, a sub-clinical infection can cause raised counts, as can inflammation. (Most labs have monocyte upper reference limits of around 0.8 to 1.0.)

The variation in your lymphocyte count is quite normal and is actually rather stable, as well as being low for someone with a CLL/SLL diagnosis.

NEVER look at percentages of white blood cell types when you have CLL. They are dangerously misleading - just as you have probably been misled in your concern that your neutrophils are dropping. Always monitor the absolute counts, which ideally should be over 1.5. Given your WBC has increased from 11 to 13, your absolute neutrophil count could have stayed the same or even increased while your neutrophil count percentage dropped, due to the increase in your monocyte count. See: healthunlocked.com/cllsuppo... A neutrophil count of 2.73 (21% of 13) is quite adequate.

Neil