Questions about lymphocytes. Rollercoasting blood count phenomenon - Is it part of the picture?

[StriatedCaracara]

I believe the normal range for lymphocytes is 1 to 4 x10*9/L

I have been looking closely at lymphocyte levels during my last lupus flare.

During which time I've had blood tests at a hospital appointment, my GP surgery and at A&E.

Lymphocyte levels seemed to change quite quickly, even within the space of a few days.

Here is my example:

Day 1 at Hospital appointment 0.87

Day 6 at GP surgery 1.74

Day 20 at A&E 0.68

I can't really understand this. Also I wondered whether methods used to do the counts could vary or if there can be wide margins of error.

The rollercoasting is quite big. How can the level double so quickly over 6 days from 0.87 to 1.74 and then fall back down to 0.68. What is happening in the body and what is happening with the actual lymphocytes, once they are made, where do they go and why do their levels go down and then up and down again so quickly?

Thanks

[StriatedCaracara]

Secondly

Even though 0.87 and 0.68 show in red as low, doctors did not seem to have any concern. They only seemed concerned with the symptoms. My GP record only shows the GP surgery result not the two hospital ones. Why don't GP systems import hospital results so they have the full picture?

How low do bloods have to go before doctors remark on them?

I thought from ARC 1987 ..1997 '4 out of 11 Criteria' that 1.5 was low, then with SLICC 2012 it was 1.0 and now in2023 it seems to be 0.5.

Why, over the years, have criteria change to exclude rather than include ?

Do they want to reduce number of patients needing review and even to be retested?

[DebbieJ6894 in reply to StriatedCaracara]

I've been told by doctors that the key thing with blood test results is that, while they use the "normal range criteria" the levels are to some extent individual to the patient, so they would need to look at your lymphocyte results when you are not having a flare to compare these to the results during the flare to see how bad the flare is, if that makes sense? I suppose that would explain why they are more concerned at the moment with the actual symptoms? [Though I have to say that I have found that hospital doctors often try to reduce the number of patients needing review/retesting - this has happened to me.]

Looking at the issue of low lymphocytes, this is called lymphocytopenia and usually caused by 1 of 3 things, one of which is your body making "enough lymphocytes and other blood cells, but they're being destroyed faster than your bone marrow can replace them. This can been seen in autoimmune diseases." [from myclevelandclinic.org] There are other things that could cause low lymphocytes, but this seems the most likely in your case?

[StriatedCaracara in reply to DebbieJ6894]

Never realised that anti-lymphocyte antibodies (ALA) might be being made too:

Antilymphocyte antibodies in systemic lupus erythematosus: association with disease activity and lymphopenia

pubmed.ncbi.nlm.nih.gov/248...

Full text

ncbi.nlm.nih.gov/pmc/articl...

[Broseley]

Hi, I have PMR and GCA and I'm on prednisolone which raises your neutrophils, but my GP wanted to retest anyway. The next test: neutrophils normal but raised lymphocytes (lymphocytosis) and some evidence of hairy cells! GP said he knew nothing about this so I Googled it of course, and came up with hairy cell leukaemia. Scary or what. Another blood test to do some sort of measurement on the lymphocytes (I can't remember what) and it was back to normal again, nothing to worry about.

So my experience matches yours, but I have no idea why.

[StriatedCaracara in reply to Broseley]

Just realised my hospital lymphocyte blood results are lower than my GP ones.

Think this is bit strange. Some are just a few days apart and so very different

GP surgery don't import hospital ones so never know of them unless told.

[Broseley in reply to StriatedCaracara]

I don't know where GPs in the UK get bloods done. I assumed it was the same place as the hospital. I have another blood test on Wednesday for my rheumy appointment, so it'll be interesting to see if the results differ.

[StriatedCaracara in reply to Broseley]

Both lots of results I found on hospital website.

So GP ones were imported from there, I guess.

Can't understand why GP results are higher...maybe stress of going to hospital appt

[Broseley]

Could be. To be honest I have no idea!

[fabwheelie]

I'm guessing the second one, GP 1.74 was perhaps your lymphocytes responding eg to a lupus flare up to an infection. The others ( both slightly low but in grand scheme of things not actually that big a difference in level) might be "your normal" If you have SLE many "lupies" do get low lymphocytes, often the treatment medications can reduce the count too.Your White blood cells of which Lymphocytes are one type do respond quite quickly in the body, including in "normal population" so seeing a variation from one test result to another isn't that unusual

[MEGS53]

lymphocytes consist of a very heterogeneous population. Some stay in the circulation for hours to days while other subtypes hang around for years