Monocytes increase

[Cookiebaker]

I haven’t written for awhile although I read posts every day. I have ET with MPL mutation. I take Hydroxyurea. Does it increase monocytes percentage? I had blood work done recently...I don’t see hematologist for another month so I haven’t gotten a chance to inquire from him but notice monocytes percentage are 13.5 ...above normal. They have been increasing every time I have blood work done. Is this a side effect from Hydroxyurea? Thank you.

[hunter5582]

HU a cytoreductive agent. It decreases all hematopoiesis. Would expect that it would decrease monocytes if anything. Would increase in reaction to injury or infection. Some people with PV also experience leukocytosis, but would not think that would apply to you. Monocytes are part of your immune response. Have you had any recent infection or other medical issues going on?

[Cookiebaker]

No. I haven’t had any illness or infection. I am anxious to see hematologist next month. And have blood done again. Thank you for your wisdom . The goofy thing was my wbc was 3.00 but high monocytes.

[clubdino]

Hi. I've researched this a little bit because my monocytes have been rising but haven't hit the abnormal range yet. I don't take hydroxyurea or any treatment. Monocytosis can happen with MPNs. There is such a thing as monocytic leukemia but if you are diagnosed with a MPN first and then your monocytes rise then it is usually considered a symptom of a MPN and not monocytic leukemia. Are you looking at an absolute count or just the monocyte percentage. Doctors usually only worry about the absolute count because lets say your body isn't making as many neutrophils for some reason then it will make the other wbc's look elevated even though they aren't. I'm not explaining that well but I'm sure your doctor will be able to explain it better. Actually seeing that your WBC count is only 3 it may be you have monocytosis due to neutropenia.

Grabbed from the article linked below:

"Cases of MPN can be associated with monocytosis or they can develop it during the course of the disease. These cases may simulate CMML. In these rare instances, a previous documented history of MPN excludes CMML, while the presence of MPN features in the bone marrow and/or of MPN-associated mutations (JAK2, CALR or MPL) tend to support MPN with monocytosis rather than CMML."

mds-europe.eu/management/di...

CMML is chronic myelomonocytic leukemia. So in your case it may just be your monocytes are rising due to your MPN or your monocytes are elevated due to a low neutrophil count. Hope that helps.

*Also with your WBC on the low side watch out for any fevers or opportunistic infections and if you notice those contact your doctor right away. With your WBC count I would also ask your doctor if your ET is possibly transforming to MF.

[Cookiebaker in reply to clubdino]

Thank you for your research. I read about monocytic leukemia and that didn’t sound like fun. I do have neutropenia . I should have included that is my post . I had that before my diagnosis of ET. The monocyte percent for me is what is high. Again thank you.

[clubdino in reply to Cookiebaker]

Hmm. Hydroxyurea is contraindicated in people with WBC count at 2.5 or under which you are very close to. I'd maybe ask the doc if another med may be better for you.

[Cookiebaker in reply to clubdino]

The doc talked of changes in treatment if counts decreased. Thank you.,

[Cookiebaker in reply to clubdino]

I bet you are right about the rise of monocytes being caused from ET . I sure hope it isn’t CMML . Actually wish he would do a bone marrow biopsy. And maybe he will. Have to wait until December to find out. Thank you clubdino and hunter for your responses.

[clubdino in reply to Cookiebaker]

No problem. One of the requirements to be diagnosed with cmml is to never have been diagnosed with a MPN first. They would just call it a mpn with monocytosis.

I lean more towards the way that your monocyte percentage is high because your neutrophil percentage is low. For instance, when a CBC differential is read by human eyes and not a machine the person will look at a slide and count 100 cells. The 5 white blood cell types in most popular order are:

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

So if your body isn't making as many neutrophils as usual possibly due to the hydroxyurea then another cell has to take its place in the 100 cell count. Eosinophils and basophils are rare. So that would leave the lymphocytes and monocytes to take the place of the neutrophil in the 100 cell count. Neutrophils are the most important white blood cells. They are what fight infections. That is why when people are getting heavy-duty chemotherapy drugs the doctor will always do blood work ahead of time to make sure that the person has enough neutrophils. The reason being is it is expected that the chemotherapy will lower the neutrophil count and if the neutrophil count goes too low it is life threatening.

Now if you had a high white blood cell count and a high monocyte percentage that would be a true monocytosis. Your declining neutrophil count will be of more concern to your doctor.

I used to be an oncology technician in an animal hospital. I would read the blood smears for the animals receiving chemotherapy. The oncologist I worked for had a cut off of 2500 neutrophils. If an animal came in for their chemotherapy appointment and the animal had less than 2500 neutrophils (2.5) then they would not get chemotherapy that day under any circumstances. Hydroxyurea probably isn't going to bottom out your neutrophil count suddenly so don't let that part scare you but if your neutrophil count continues to trend downwards then your doctor will have to switch your medication. This is all just a guess on my part but at least it's an educated guess. With your sisters history of MF I would request a BMB if you've never had one. If he balks then I would demand one because you may already have MF. Sometimes doctors need a little push. Good luck at your appointment and please let us know how it goes.

[Cookiebaker in reply to clubdino]

You are lucky to have the background with blood work. Thank you for the explanation about the percentages. I bet your educated guess is correct about CMML

. I expect my ET to become MF at some point. I tolerate the Hydroxyurea well and dread having to take a different drug. There were not many options for treatment when my sister passed in 2009.

Thank you for sharing your knowledge.

[Rackon2]

Dear Cookiebaker

I've been on hydroxyurea since March. My red blood cells were high end of normal and platelet s were also high normal. The hydroxyurea has been bringing my counts down slowly. I'm on 1 x500 per day. I've had no real side effects except I'm really tired and feel weak. I have a vague diagnosis of mpn for sure. I have a hematologist at the best cancer clinic and a specialest at one of the top hospitals in Toronto . So I'm floundering on my own trying to learn what to expect of my self . I feel very alone. I read some of the posts every evening at bedtime. My family knows very little about what is going on with me.

Sorry I haven't been much help but you have helped me to reach out. Thank you

[Cookiebaker in reply to Rackon2]

This is a good spot to learn about MPN’s. There are some smart people who share their knowledge with people like you and me ! Glad you are here.