Happy New Year to all!
A question for those experts, whose knowledge I greatly appreciate.
I had my three month blood work during watch and wait today. All looks stable. But I don't under stand the difference between Gran% which was low at 21 and Absolute Neutrophil Count which was in normal range of 2.8 but was 6.2 three months ago and 4.2 prior to that. Is there a correlation between gran and ANC? Do they usually fluctuate like this? Thanks so much for any input.
neutrophils, eosinophils, and basophils are Granulocytes, so the grans% includes the other two, while the Neutrophils# (absolute) speaks for itself. And Happy New Year to you!
Read on for Neil's replies for guidance.
I would really appreciate it if you could attach a photo of the section of your blood test report, showing the white blood cell differential report. That's because this section, which breaks down the makeup of your 5 different white blood cell types, is annoyingly not standard. At its simplest, it provides a total White Blood Cell (WBC) count, then percentages of neutrophils (also termed granulocytes or segs (because of the segmented nuclei)), lymphocytes, monocytes, eosinophils and basophils. Some differential reports (as it seems yours does), then list the absolute counts of the individual white blood cell types. Some reports show the percentage and then the absolute count; there are endless permutations! I'm interested, because it seems yours lists Gran% and neutrophils (perhaps neut#), not gran#
If this is too hard, just forget the percentages*. That's because when you have CLL, looking at the percentages is downright confusing if not dangerous. Just track the absolute numbers. You don't need the percentages if you have the absolute numbers provided. (If you only have the percentage, you can get the absolute number by multiplying the percentage by the WBC total count.) Any neutrophil/granulocyte count over 1.5 is adequate, with higher counts up to around 8 or so in the healthy range. Your ANC counts are perfectly fine!
*The reason for this confusion, is that, by definition, percentages must sum to 100%. That means that when you have CLL and your lymphocyte count climbs, your percentage of lymphocytes also climbs. That means that the other white cell percentages must fall even if the absolute counts climb a bit less than the lymphocyte count climbs. That's why checking percentages can fool you. Ignore percentages when you have absolute counts. See the following:
healthunlocked.com/cllsuppo...
healthunlocked.com/cllsuppo...
Neil
Thank you Neil- Blood work picture below
That is indeed one of the weirdest CBC report forms I've seen. I suspect that at sometime in the life of the form template, they had Gran% and Gran# in keeping with the other entries. Then someone changed the Gran# on the form template to ANC (absolute neutrophil count), which usually means the same, but sometimes granulocytes can include neutrophils, eosinophils and basophils as cllady01 noted. The form should be consistent and list Neut% and Neut#. You might like to point that out to your lab. I do like that they show the previous absolute counts, but not the previous (possibly misleading) percentages.
Anyway, as I noted above, you can get the absolute neutrophil/granulocyte count by multiplying the WBC by the gran% and indeed 13.2 x 21.5% gives you 2.838, which matches the ANC (Gran#) of 2.8.
Importantly, your results are pretty good. Most of the drop in your WBC is due to the considerable (but perfectly normal) drop in your neutrophil count. This is why you should track your absolute lymphocyte count (ALC or Lymph# on your report), to track changes in your CLL blood tumour burden, not your WBC.
You'll also note that your neutrophil count is not low, just the percentage is low, because your absolute lymphocyte count is high, as you have CLL.
Neil
The "new improved updated" CBC reports I am now getting as of last year, are including percentages. The do have absolute counts, but one has to scroll through the data. I suspect it has something to do with looking for bands, it's easier at a glance to decide if the percent is "within normal limits" of otherwise healthy patients, or if a left shift has drastically changed (without having to do the lercentage calculation in one's head). And of course they also put in all the other cell percentages, to verify everything does indeed total 100% and there's not some sort of error. Plus lab values of "normal" can also change a bit, depending on the lab used!
I just wish we had standardised blood test reports. We can't even get them standardised within the same country. Every lab has to reinvent the wheel!
Hello AussieNeil
That is very true, I have to re-decipher my reports every time a different lab does the blood work up. My hospital recently changed to Quest Labs and that is a whole different story. Blessings.
Thank you Neil for time and consideration of my blood work. You have helped me so much as I navigate my first year of a CLL diagnosis. Your insight is invaluable- Happy New Year to all!
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