am at end of cycle 3 of o+v
Today monocytes 31%
I did need neupogen shot - wbc 1.6 and anc .6
does anyone know if this monocyte number is cause for concern, has anyone had this kind of thing before? This no has never been above 20 for me since I started treatment. I have had zero side effects. Thank you
Hi SurfSurf,
This immediately leapt out at me from your post - "Today monocytes 31% ". 31% of a WBC 1.6 gives you an absolute monocyte count of 0.496. The reference range for monocytes is typically around 0.2 to 0.8, so your monocyte count is nicely in the middle of the healthy range.
Always, always look at absolute counts when you have CLL. The gyrations in lymphocyte counts (high to very high in watch and wait, often driven very low when in treatment as in your case), cause very misleading distortions in your other white blood cell count percentages. That's because the total percentage of white blood cells must add to 100%. If you have a high lymphocyte count, then you can see misleadingly low percentages for other white blood cell counts, and conversely the opposite when you have a low lymphocyte count, as in your case.
Here's a worked example of why looking at percentages can cause unwarranted concern about neutropenia when the neutrophil count has improved! healthunlocked.com/cllsuppo...
Good to see that your stage 3 neutropenia (between 0.5 and 1.0) is being well managed.
Neil
Hi AussieNeil,
Was hoping you would reply, can’t think you enough! I remember you’ve posted many times don’t look at percentages! Questions:
1. Monocyte parameter is showing (0%-12.3%) and my number 31% (high). Could this be “normal?” The report doesn’t give a monocyte absolute number.
2. Under Megakaryocyte the parameter is zero and my number is zero, but, for the first time ever (since June) there is this comment:
“Cells classified as “mega fragment” may include micromegakaryocytes and/or megakaryocyte nuclear remnants.”
Thank you for any info on these two pts.
1) The "Monocyte parameter is showing (0%-12.3%)" is for people with normal lymphocyte counts. Given your white blood differential results are given in percentages, you unfortunately have to first calculate the absolute counts for white blood cells in which you are interested, by multiplying the percentage given by the total WBC - just as I have done. It's nigh impossible to provide guidance percentages for white blood cells when we have CLL, as your results have shown in three different areas; your monocyte count is completely normal, your lymphocyte count and your neutrophil counts are both very, very low, which means that other counts must go higher (100% - low neut% -low lymph%) = every other white blood cell percentage (monocytes, eosinophils, basophils) must be correspondingly high to make up number up to 100%.) Typically neutrophil counts average around 2 to 8 and lymphocytes around 1 to 3.5, or around 60% and 20% of the total WBC respectively. With a WBC 1.6 and ANC 0.6, plus our calculated monocyte count of 0.5, your lymphocyte, basophil and eosinophil counts total (1.6 - 0.6 - 0.5) or 0.5.
2) I don't know why your pathology lab have included that Megakaryocyte comment given you have zero reported. Per Wikipedia "A megakaryocyte ( mega- + karyo- + -cyte, "large-nucleus cell") is a large bone marrow cell with a lobated nucleus that produces blood platelets (thrombocytes)"
Neil
Thank you AussieNeil, I (finally) got it. Will try to lower the anxiety here in NYC! Appreciate your quick and well explained replies.
Hi Neil,
My Dr. just called and confirmed exactly what you wrote re my monocytes number.
The comment on my differential, he didn’t know why they wrote that as my number is zero.
He did note he thinks my hemoglobin is low for going into cycle 4 (next week). My hemoglobin was 8.8 yesterday - he said “low HGB” could be sign of marrow suppression, iron deficiency or something with CLL (didn’t catch what he said). Any ideas how to bring this HGB up or have you seen this before? My HGB the day I started with obin was 8.9.
Thank you
Susan
Susan, as your doctor notes, there are basically five reasons (or a combination thereof) for low haemoglobin, in roughly this order of priority when we have CLL;
1) CLL bone marrow infiltration, reducing the amount of bone marrow usable as your blood cell manufacturing center
2) Bone marrow suppression from treatment drugs
3) An enlarged spleen, filtering out red blood cells, when they still have plenty of life in them
4) Not enough nutrients to make what we need (usually a deficiency in iron, B12, or folate (B9)
5) An auto-immune disease - Autoimmune Haemolytic Anaemia, which is more common in CLL, through which we sometimes make antibodies that attack and destroy our haemoglobin containing red blood cells
The reason for the treatment trigger of haemoglobin dropping under 10 to commence treatment, is to allow for a buffer for the impact of (2). Eventually, treatment should clear out the bone marrow and as it recovers, your haemoglobin will improve. Sometimes our haemoglobin can drop to dangerous levels - under 6 and we risk organ damage. That's why sometimes we may be given packed red blood cell transfusions to support us until our bone marrow recovers - typically when it drops under 8.0. I needed a couple within my first month of treatment. My haemoglobin is now the best it has been in over 17 years - from a few years before I was diagnosed with CLL/SLL. (I also needed an iron infusion after my red blood cell count recovered to within the healthy range while my haemoglobin recovery stalled. Your doctor is obviously keeping an eye on what's happening, so should arrange whatever you might need.
Neil
Neil,
You explained this much better than my Doctor, thank you! The lowest my HGB went was 7.5 and they said they’d give me blood transfusion under 7.0. The fact your HGB is the best in 17 years gives me hope I can make it through this, like others have written the fear and anxiety is sometimes the worst thing about CLL.
Susan
high WBC count with Brukinsa
High EOSINOPHILIA labs
Imbrutinib and High Blood Pressure
High Alkaline Phosphatase 
High level of uric acid
