Different ALC numbers

[Kiwidi]

So today I went for a pre admission appointment for my knee replacement. Had to have a CBC for that and my Gp had also ordered one . So they were both done on the same draw. For one the result was ALC was 90.4 and for the other 97.5. All other numbers were within the normal range. Just wondering how this could happen? Is anyone able to throw any light on this?

[AussieNeil Administrator]

Thank you for illustrating why trends are so important and why we shouldn't get stressed by a change in our ALC or WBC. I reported my similar recent experience in this post: healthunlocked.com/cllsuppo...

Here's why:

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Neil

[Kiwidi in reply to AussieNeil]

Thank you so much for your prompt reply., it totally throws light on my question. Makes me a bit dubious about this whole ‘dependence ‘on numbers. I am concerned thst my my wbc is climbing but while everything else is ok I will be ok. And in the meantime hopefully NZ will catch up with the rest of the world in the availability of treatment!

[AussieNeil Administrator in reply to Kiwidi]

A good specialist treats the person, not the numbers.

[Kiwidi in reply to AussieNeil]

Haha! As long you can get a specialist! I am my own specialist as no referral in NZ to a specialist until you have symptoms other than high numbers.

[AussieNeil Administrator in reply to Kiwidi]

Actually that almost makes sense, not being able to get access to a specialist unless you have more than just a high lymphocyte count, as you appreciated in your reply to this post:-

What are the Symptoms of High Lymphocytes?

healthunlocked.com/cllsuppo...

After finding out that you can get an ~8% error in the lymphocyte blood count from the same sample of blood, you can appreciate how difficult it is to work out whether anything you are taking or doing is having an effect on your CLL .

Neil

[wellbeingwarrior in reply to Kiwidi]

Hi Kiwidi. Have you considered seeing a Specialist privately? I see mine privately in NZ and it's the best thing I did in terms of feeling I am talking to someone who knows what they're talking about and can answer my questions through an informed specialist lens. Although I have private medical insurance that covers this, honestly I'd pay for the consultations myself just to get that peace of mind that everything that is going on for me is being considered. I found I knew more than my GP anyway about my CLL and that frustrated me as she couldn't answer my questions...

[CycleWonder]

My CLL specialist looks at results from other labs but doesn’t rely on those results. He likes to stick to making decisions on results from one lab, along with other factors.

[AussieNeil Administrator in reply to CycleWonder]

Same lab, using same equipment, same time, same schedule for the day beforehand, including leisurely walking, rather than rushing there, is what you need for the most consistent labs for comparison with previous labs. Same phlebotomist using the same technique also helps significantly (butterfly valve and syringe collection vs vacuum collection for example), as does going to where the blood is tested, rather than a collection center, from which you add in the vagaries of storage and transport. You can now appreciate why doctors just arrange for a second test some time later, if there are any surprises.

Neil

[CycleWonder in reply to AussieNeil]

At the center I go to for CLL care, the blood is tested on site. So the transport is walking from one room to another! He said paying the most attention to their lab results eliminates one more factor in comparing results.

[SofiaDeo in reply to AussieNeil]

I get more breakage from butterfly/syringe method. I have large, friable lymphocytes not small ones. The phlebotomist also told me, no exercise before collections. I used to climb the stairs (no one ever there, compared to the elevators) to get to my appointments.

[CycleWonder in reply to SofiaDeo]

Why no exercise before the blood draw? Does that mean the day of or does that include the day before? I usually try to go for a bike ride the day before to help relieve stress and somehow that provides more confidence.

[AussieNeil Administrator in reply to CycleWonder]

Brisk exercise can boost your neutrophil count for a while. I'm guessing a few hours. It does this by encouraging their release from blood vessel walls and the spleen. So that's probably not a good idea if you are bordering on neutropenia, as you might end with a false sense of confidence.

Neil

[CycleWonder in reply to AussieNeil]

So the day before to exercise is OK? My usual day of routine does not vary much. We get up, eat breakfast, then drive for an hour to get there. We do walk about a block to get to the right building but we are not pushing it. Just walking.

[SofiaDeo in reply to CycleWonder]

She meant, "don't climb stairs in the building on the way into your appointment." Like, immediately before the blood draw. Not to avoid my AM walk or anything else, although I wouldn't do strenuous exercise immediately before leaving for a doc appointment with a blood draw, either. Sedate walking is OK, it's just avoiding aerobic stuff immediately before. I climb fast, skipping steps, trying to get in "spurts" of aerobics. Which she said was not optimal. I now climb one step at a time, slowly, if I think the elevators are too crowded. It's only 2 flights so not enough to get my blood moving fast unless I am jumping.

[morepork]

Wishing you all the best for your forthcoming surgery, from a fellow Kiwi; and also nodding along with the informed answers you got here about the normal fluctuations in blood test numbers - I keep a spreadsheet of my test results and watch my numbers dance up and down the graph lines.

Like you I found it's our GP who manages our CLL till such time as alarm bells sound and we are referred - though I have to confess I forced my way into a OPD CLL clinic many years ago when I was aggressively proactive and wanted detailed answers that my GP could not provide.

Kia ora

Stephanie

[skipro]

lab error is not all that uncommon.

Good luck

Skipro and physician