High neutrophil count😱

[jointpain]

My wife's last blood test showed her platelets were up at @800 And her neutrophil count at over 70, her Hgb was 116, hematocrit was 0.38 which is high for her, but as it was only three weeks since she had three units of packed red cells and a bag of iron, that was expected. I read in the guardian of a painkiller on sale in Spain which is banned in many countries because it reduces the neutrophil count. I've asked her hematologist for his thoughts on it. I'm not saying that she should be given this drug to reduce her neutrophil count, but it is rather high, with no evidence of infection. She has had a splenectomy which normally increase the white cell count, as there isn't a reserve of white cells stored in the spleen. Here is an excerpt from the story. The drug metamizole, commonly sold in Spain under the brand name Nolotil, is banned in several countries, including Britain, the US, India and Australia. It can cause a condition known as agranulocytosis, which reduces white blood cells, increasing the risk of potentially fatal infection.

The Association of Drug Affected Patients (ADAF) says adverse reactions to the drugs have led to sepsis, organ failure and amputations. It has identified about 350 suspected cases of agranulocytosis between 1996 and 2023, including those of 170 Britons who live in Spain or were on holiday there.

[hunter5582]

It is hard to evaluate a single lab read without knowing the context and the history of neutrophil count as well as the other blood cell numbers. It is normal for platelets to vary by as much as 100K. Other blood cell numbers are also expected to vary based on what is going on in the body. It is the history and trends over time that matter, not single lab reads.

Note that the reference range can vary by lab. There should be two numbers noted for NEUT, the absolute number neutrophils and the percentage of leukocytes that are comprised of neutrophils. The absolute number indicates how many NEUT are present. The reference range should look something like this, absolute [1.56 - 6.13 10^3/uL] percent [34.0 - 71.1%].

Suggest your wife review her history of Neutrophils and the other blood cell numbers with her MPN Specialist. It is reasonable to want to know the significance of the NEUT level but worth noting that intervention may not be indicated. We always have to weigh the risk of any medications we add. The benefits need to clearly outweigh the risks. It may be better to monitor a low level of escalation in NEUT if the elevation poses no particular risk.

Please do let us know how your wife gets on and what she learns.

[jointpain in reply to hunter5582]

Thank you Hunter for your reply. My wife does keep a record of all her blood tests. It does seem her neutrophil count has been steadily increasing over the last five years, from around 20 to 70. There are spikes it seems whenever she has either a COVID vaccination or large red cell transfusions with ferinject the same day. The spikes also found to be in platelet numbers too, which possibly denote an infection or a reaction to the assault on her body from the vaccines and transfusions. Her MPN specialist doesn't really exist, though he is the head hematologist at the hospital, with probably 50 years as a consultant. He does accuse my wife and myself of overthinking things, but does congratulate me for getting many things right that he misses. Her platelets have decreased to 560 from 839 in two weeks and her white cells decreased from 73 to 50 too. That was taking an extra 2 hydroxycarbamide a week more instead of the extra 4 a week he wanted her to take. Last time she spiked he had her take one a day instead of the 3 a week and within ten days she was bruising and her platelets had dropped from 880 to 45. So she really has to keep an eye on what she feels is right for her.

Keep safe.

[hunter5582 in reply to jointpain]

Since the increase in NEUT is a steady pattern, it is something to have explained. If the "MPN specialist doesn't really exist" then I would be thinking about finding one that does exist. Perhaps a second opinion or transfer of care is in order. It may be that a change in treatment plan is in order. Hopefully. momelotinib will be available soon for those whose MF includes anemia. This is something to discuss with a MPN Specialist who really exists and is up to date on the current treatment options.

Wishing you both all the best.