
What Causes Drop In White Blood Cell Count?

I am 36 year old female, and have been in very good health until April of this year. I went to the Emergency Room with left side pain, my entire left side felt inflamed from beneath my shoulder to above my hip. The only thing the E.R. could find was anemia - iron 9 , hemoglobin 9.1 . Since then my blood work has stayed relatively the same, I started taking iron supplements and my iron went up to 15, but my hemoglobin went down to 8.8, and then my white blood count which was normal also dropped to below normal, 3.3. I lost about 25 pounds from April until now because of the left side pain and a new pain that started happening, stabbing pain above my belly button related to eating food. The drop in white blood cell count suddenly to below normal concerns me. I am not sure how to read the CBC as a whole and not sure which values I should be concerned about. I am hoping to get someone to review my last few CBC's and let me know if you think there is anything more of concern besides just iron deficient anemia.
Considerations
Detailed Answer:
Hello and thank you for sending the question.
From the complete blood count results that you have sent it does appear that you have changes consistent with iron deficiency anemia. I would be most impressed to know the results of your iron studies. This would include iron, iron binding capacity and ferritin level. The ferritin level is the most accurate measurement of your storage iron level.
Now we must try to determine why you have iron deficiency anemia. This is usually related to some type of blood loss. This could be from heavy menstrual bleeding or possibly gastrointestinal bleeding. For this reason there does need to be an investigation from your gynecologist or a gastroenterologist to make sure there is not any active bleeding going on. This is especially important since you are reporting some type of pain as well.
Iron can be difficult to tolerate taking by mouth. It is extremely important that you take iron along with vitamin C. The reason why we recommend vitamin C is that this helps your body absorb the iron supplement. Usually I have patients take iron three times per day with vitamin C if they can tolerate it. If you cannot tolerated your doctor might suggest intravenous iron infusions.
At this time I think the most important thing is to try to determine why you have the anemia. Then your doctors can hopefully help to address this underlying issue.
If oral iron supplementation is not tolerable then I would suggest you discussed this with a hematologist who might be able to provide you with some iron infusions to help restore your iron. If your body does not have enough fire and your bone marrow cannot produce enough blood cells and you may remain anemic and may experience symptoms associated with anemia including weakness.
thank you again for sending your question. Please let us know if you have any additional questions.
Dr. Galamaga


Followup
Detailed Answer:
At 3,3 this is not generally concerning. Your immune system is still likely more than adequate in defending against typical infections.
It is not uncommon to see the BC count fluctuate around the low end of normal. Your doctor will check again I am sure and might also consider checking B12, folate and thyroid function.
Thanks again for the query and for sharing your health care concerns with us.
Dr Galamaga

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