WBC Dropped 50%

[whitravis]

No change in symptoms but last two routine labs have shown about 50% drop in WBC from about12,000 to about 6,000. Platelets and INR ok. I'm treatment naive, WnW. What to make of this drop on WBC count?

[SeymourB]

whitravis -

Great!

Which white cell types dropped?

What was your lymphocyte count before and after?

At such a low WBC level, an infection can drive neutrophils, monocytes, and lymphocytes up. CLL is a lymphocyte disease, so that count is more important than the whole WBC, which includes every white cell type.

Are you getting over an infection or illness?

=seymour=

[whitravis in reply to SeymourB]

Seymore - thanks for reply.

I had a couple of "cold" type viruses around that time.

J uly 2023. WBC 19K Abs lymphs 14

Dec 2023. WBC 24K ALC 18

JAN 2024 WBC 19K. ALC 15 Plt 152

April 2024. 8.4 WBC. ALC 4.7 plt 113

I'm familiar with various types of WBC but puzzled as to explain significant drop in WBC

[SeymourB in reply to whitravis]

whitravis -

You're still at a very low ALC. An infection can cause what looks like a significant rise in ALC at your levels. Then, when you get better, the lymphocytes can drop again.

Some viruses even suppress lymphocytes for awhile, especially COVID.

Again, WBC is not the thing to watch. At your level, watch ALC, Neutrophils, and Monocytes. All 3 of those go up with infections, and back down again when it resolves.

=seymour=

[whitravis in reply to SeymourB]

Appreciate the input!

[neurodervish]

Just to add to Seymour's answer, here's a handy illustration of what makes up our white blood cells. Borrowed from my.clevelandclinic.org/heal...

White blood cells are made of these

[AussieNeil Partner Administrator]

I'm glad you now appreciate the importance of monitoring your Absolute Lymphocyte Count (ALC) rather than your WBC. There's more discussed about this in this pinned post. healthunlocked.com/cllsuppo... I've also included ALC plots from 21 early stage CLL patients. Your ALC also includes health B, cytotoxic and helper T and natural killer cells, all of which have less and less of an influence on your ALC when it climbs from CLL cell accumulation. This is why CLL specialists don't pay that much attention to ALC doubling time until your ALC climbs above 30 x 10^ 9 cells per litre.

Finally, always keep in mind that your ALC is just the cheapest and easiest way to monitor how your health is affected by your CLL. ALC counts can go quite high without concern - with some CLL specialists reporting patients with counts over 1,000. CLL cells are small, about the same size as red blood cells, and even with an ALC count of 1,000, red blood cells still outnumber them by around 5:1. With CLL, we need to consider how our total CLL tumour burden is affecting us -typically we the development of a swollen spleen (perhaps liver and other organs), nodes and bone marrow infiltration. Scans can much more thoroughly assess node and organ swelling, but a good specialist should also check by physical examination of your nodes in your armpits, neck, groin and abdomen, as well as checking your spleen and liver. While a bone marrow biopsy is needed to sample the amount of CLL infiltration, checking for downward trends in our haemoglobin, platelets and neutrophils is a good proxy.

Checking our neutrophil and immunoglobulin counts provides a measure of the impact of our CLL on our immunity, but the best measure is how often we become ill from infections and how quickly we clear those infections.

Neil

Absolute Lymphocyte Counts (ALCs) can vary a great deal over time in early stage CLL

[LeoPa]

Cool!Maybe one of the infections triggered an immune response that's under way to cure your CLL. Definitely watch the trend and do a post if the numbers keep normalizing. Miracles do happen. May this be one of them.