Brief Answer:
Can you send me your latest blood report with WBC differential count.

Detailed Answer:
Hello sir.I did review your symptoms.

Nplate is Romiplostim. It is a Thrombopoeitin stimulant. Since precursors of RBC, Platelets and WBCs are very closely related to each other, Romiplostim can infrequently cause leukocytosis. Apart from that You are also using hydrocortisone which also can cause leukocytosis especially neutrophilia.

However, what I wanted to see was the differential count of the latest WBC count that you had. Sometimes Romiplostim can cause release of blast cells in peripheral blood in people with a condition known as myelodysplasia.

I would also like to advice you to get a morphological review from a hematopathologist about the morphology of WBC and RBC if it has not been done. Also, if there is any suspicion on the part of doctor there will be a bone marrow study that can be done.

Another common side effects of Nplate are headache and dizziness and muscle aches. many patients have that initially atleast. There are some patients who also have developed thrombus formation but that is relatively uncommon and not to be worried about right now.

As far as your hemoglohin is concerned, it seems borderline low and I am not worried much about it. Only if it drops below 12.5 then we should start investigating for the causes.
So all in all,
Leukocytosis is a infrequent side effect of Nplate as well as hydrocortisone but it needs to be seen which WBCs are increased and what is their morphology(how they look like) so-
1) I would recommend you to send me the latest blood report with WBC differential count and a morphological review of blood slide.
2) Get a morphological review done by a hematopathologist if not done recently and if required in the later stages get a bone marrow study done (but not needed emergently).

I hope this helps.
Let me know if you have any questions or concerns sir.
Wish you all the best.
Sincerely,
Dr Parth Desai.

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Brief Answer:
I would advice a flow cytometry analysis of your peripheral blood

Detailed Answer:
Hi I did review your reply query sir.
The WBC count is elevated with predominantly increased lymphocyte count (61%).

I would advice a flow cytometric study of your peripheral blood as well as a bone marrow study in view of lymphocytosis and presence of few atypical lymphocytosis and presence of smudge cells. They are suspicious of a condition known as CLL (chronic lymphocytic leukemia) or it could be reactive lymphocytosis due to some recent infection which can be easily differentiated by flow cytometric study.

Have you noticed any lumps and bumps in your neck or axilla or groin?
Has your spleen been removed for ITP or if not have you noticed any abdominal fullness?

So all in all my recommendations right now are-
1) Flow cytometry analysis of your peripheral blood
2) Bone marrow study with cytogenetics and flow cytometry on it.

I hope this helps.
Let me know if you have any questions or concerns sir.
Wish you all the best.
Sincerely,
Dr Parth Desai.

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