WBC Is 1.7. It Has Been Decreasing For Around 6

Posted on Tue, 14 Jul 2020

Question: WBC is 1.7. It has been decreasing for around 6 - 7 months. I have RA which has been flaring up. For that I take NDSAID’s. Other than that no symptoms other than what the RA is causing.

Should I be concerned? Chance of cancer?

Follow up: Dr. Indranil Ghosh (0 minute later)

WBC is 1.7. It has been decreasing for around 6 - 7 months. I have RA which has been flaring up. For that I take NDSAID’s. Other than that no symptoms other than what the RA is causing.

Should I be concerned? Chance of cancer?

Answered by Dr. Indranil Ghosh (3 hours later)

Brief Answer:
We need some more information

Detailed Answer:
Hi
Thanks for your query.

WBC of 1.7 is low enough to be of concern. Can you share the entire blood count report? That would help us a lot to guide you better. Also, we would like to know if you are on any other medicine for RA. These medicines can often reduce white cell counts.

If only WBC is low then chance of cancer is low. However, based on your inputs I will suggest further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Indranil Ghosh (0 minute later)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (12 hours later)

See below for past and current results. Currently not taking any medication for RA except for OTC NSAIDs.

          NEUTROPHILS % MAN CNT
3/20/2018          11
10/16/2018     37
6/13/2020          20.3

          BAND'S % MAN CNT     0.0 - 10.0 %
3/20/2018
10/16/2018          6
6/13/2020          13.3 (H)

          LYMPHS % MAN CNT
3/20/2018          28
10/16/2018     25
6/13/2020          41.6

          MONOS % MAN CNT
3/20/2018          4
10/16/2018     8
6/13/2020          23

          EOS % MAN CNT
3/20/2018          57
10/16/2018     24
6/13/2020          0.9

          BASO'S % MAN CNT
3/20/2018          0
10/16/2018     0
6/13/2020          0.9

          PMNS MAN CNT     1.80 - 7.70 x1000/mcL
3/20/2018          0.65 (L)
10/16/2018     1.85
6/13/2020          0.57 (L)

               BAND'S MAN CNT
3/20/2018
10/16/2018     0.26
6/13/2020          0.23

          LYMPHS MAN CNT     1.00 - 3.60 x1000/mcL
3/20/2018          1.65
10/16/2018     1.08
6/13/2020          0.71 (L)

          MONOS MAN CNT     0.10 - 1.00 x1000/mcL
3/20/2018          0.24
10/16/2018     0.34
6/13/2020          0.39

          EOS MAN CNT     0.00 - 0.70 x1000/mcL
3/20/2018          3.36 (H)
10/16/2018     1.03 (H)
6/13/2020          0.02

          BASO'S MAN CNT     0.00 - 0.20 x1000/mcL
3/20/2018          0
10/16/2018     0
6/13/2020          0.02

          PLT EST     Adequate
3/20/2018          Adequate
10/16/2018     Adequate
6/13/2020          Adequate

          NRBC     <=0
3/20/2018
10/16/2018
6/13/2020          2 (H)

          ANISOCYTOSIS
3/20/2018          Few (A)
10/16/2018
6/13/2020

Follow up: Dr. Indranil Ghosh (0 minute later)

Answered by Dr. Indranil Ghosh (13 hours later)

Brief Answer:
Neutrophils persistently low

Detailed Answer:
Platelets are adequate, though information on hemoglobin not supplied. These low counts may be due to rheumatoid arthritis itself. NSAIDs alone for active RA is not good enough. I think you need disease modifying agents for RA.

Please consult any rheumatologist to get started. Chance of this being cancer is low as it is a chronic problem.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Answered by Dr. Indranil Ghosh (0 minute later)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (3 days later)

Had a follow up with rheumatologist and he stated highly unlikely RA related.

He mentioned leukemia no less than 4 times which really freaked me out. Should I request to have the biopsy done sooner or go with original plan of taking blood test in a couple of weeks and review the results?

Again, no symptoms but, of course, continue to be really concerned about cancer.

What else could it be?

Follow up: Dr. Indranil Ghosh (0 minute later)

Answered by Dr. Indranil Ghosh (9 hours later)

Brief Answer:
Leukemia unlikely

Detailed Answer:
Leukemia is not impossible but as it's a chronic problem, leukemia is unlikely. Some chronic bone marrow disorders like myelodysplastic syndrome may present like this though.

As it's long standing, waiting for 2 weeks won't change anything. You can go for the bone marrow aspiration and biopsy now to ascertain the cause.

Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Indranil Ghosh (0 minute later)

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Indranil Ghosh (1 hour later)

Isn’t myelodysplastic syndrome a type of cancer? Don’t mean to put you on the spot but based on what was presented and your professional education and experience, what do you think it is?

Thanks

Follow up: Dr. Indranil Ghosh (0 minute later)

Isn’t myelodysplastic syndrome a type of cancer? Don’t mean to put you on the spot but based on what was presented and your professional education and experience, what do you think it is?

Thanks

Answered by Dr. Indranil Ghosh (2 hours later)

Brief Answer:
No it is not cancer

Detailed Answer:
However, some MDS patients do progress to cancer in the long run.
It can be a mild form of MDS in your case. Even if it is, no urgent treatment may be required.

Above answer was peer-reviewed by : Dr. Nagamani Ng