What Do The Following Blood Test Reports Indicate?

Posted on Fri, 26 Jun 2015

Question: I hor any sighs of any problems. ave had ITP for four years and been taking Nplate. My WBC differicintal values have been going up for a year or so. I questioned my Hemo DR. She kept telling me it is because of Nplate.. I feel good ,no enlarge ,Liver ,or spleed or lyhth nodes,no weight loss , Or any other unhrealthy signs. I took a Bone marrow biopsy
2 days ago.and am waiting for results. My last values are listed here is their any ray of hope that what is causing this is not serious and something very treatable.. I an very stressed waiting for results. Red blood cells count 4.10 - 5.70 M/uL 4.59
Hgb 13.0 - 17.0 g/dL 13.0
Hematocrit 39.0 - 51.0 % 41.1
MCV 80 - 100 fL 90
RDW, RBC 12.0 - 16.5 % 15.1
Differential panel MAN DIFF
WBC COUNT 3.5 - 12.5 K/uL 20.2
Platelets count 140 - 400 K/uL 118

neutrophils % 30 manual count
lymphocytes % manual count 61%
monos % man count 5
lymphocytes atypical % 4
platelets,bld,ql, man count si decreased
platelets, morphology Giant
macrocytes 1+
microcytes 1+
spherocytes,bld,ql, light microscopy 1+
rouleaux,bld,ql, light microscopy 1+
smudge cells,bld,ql, light microscopy

Answered by Dr. Anil Parth Desai (29 minutes later)

Brief Answer:
I would recommend a flow cytometric study with bone marrow study

Detailed Answer:
Hello sir,
I did review your concern.
After having a look at your blood report it seems that your lymphocyte count is little high and there are few smudge cells in the morphological smear analysis by light microscopy.
These are indicative of a condition known as Chronic lymphocytic leukemia/lymphoma(CLL), however they can also be seen in reactive lymphocytosis.
To differentiate between these 2 conditions I would recommend that along with the bone marrow study they do a flow cytometric analysis of the blood cells and/or bone marrow cells.

I do not want you to get overtly worried because your hemoglobin and and platelet count are normal.
Even if it is CLL this condition is not very aggressive like other leukemias. Infact I have managed many of such patients who live for many years and sometimes even they do not require any treatment. And a near normal platelet count and hemoglobin is indicative of that. Apart from that a normal liver,spleen and no lymphnodes as well as no weight loss are great indicators of early disease if it is.
However, first of all right diagnosis is important and it could still be a reactive condition either due to some recent infection.

SO, all in all, I would assure you not to worry and would also recommend if you can discuss with your doctor about flow cytometric study to know the type of lymphocytes.

I hope this helps.
Wish you all the best sir.
Please let me know about any of your questions and concerns and I will be more than happy to help you.
Also please provide me feedback of your reports.
Stay positive,stay happy!
Sincerely,
Dr. Parth Desai

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anil Parth Desai (1 hour later)

I dd have a flow cytometric study alone with bone marrow study . I am just waiting for the results next week. Hopefully it will be not to serious and I will be OK in the long run. Thank you for your great explanation it makes me feel better. thats more then I got from my Hemo DR.

Answered by Dr. Anil Parth Desai (12 minutes later)

Brief Answer:
My advice would be to stay calm,not to worry and stay positive!

Detailed Answer:
Hello sir,
thank you for your reply query.
It is good that flow cytometry is being done along with bone marrow study.
So let me know when the results come and whatever it is I would advice you to take it in stride and be positive.
The good thing is that your other blood markers and clinical symptoms are not deranged and so even if it is CLL it is in early stages. Infact, many famous hematologists believe that it should not be called leukemia in an early stage as it causes unneccesary fear in patients and clinicians. It should definitely be met with caution but not fear.
Let us first get the exact diagnosis in hand then take it from there.

I hope this helps.
I want you to stay calm, relax and not to worry and be positive
Wish you all the best sir.
Let me know if you have any questions or concerns. I will be always ready to help you best I can.
Sincerely,
Dr Parth Desai

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Anil Parth Desai (2 hours later)

One last question. I have internal hemorrhoids that cause minor bleeding from Radiation treatments I had for Prostate Cancer do you feel this minor bleeding could
affect my HGB? The blood is slight and not everyday.

Answered by Dr. Anil Parth Desai (6 hours later)

Brief Answer:
I would advise treatment for it since sometimes bleeding may go unnoticed

Detailed Answer:
Hi,
thank you for your reply query.
Radiation treatment can sometimes cause scarring and hemorrhoids in lower part of rectum.
Even if its a mild bleeding and not seen by you everyday, there would be times when bleeding would occur but it go unnoticed as it could be microscopic and it could get mixed with stool. Chronic even small amount of bleeding can eventually over a period of months and years cause significant anemia

1) Although your hemoglobin is borderline normal it is slightly on lower side of normal. So I would recommend you to get it evaluated by a gastroenterologist and see what options you have to get it treated.

2) Also you can start taking iron tablets since this small bleeding may cause iron deficiency anemia in your body after months.So it is better to keep them replenished as much as possible.

I hope this helps.
Wish you all the best sir.
Let me know if you have any questions or concerns. I will be always ready to help you best I can.
Sincerely,
Dr Parth Desai

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Above answer was peer-reviewed by : Dr. Prasad