Brief Answer: Considerations. Detailed Answer: Thank you for sending your question. This is an excellent question and is actually a very common question. from the information you have described as well as the laboratory testing you have provided it does appear that your total white blood cell count is slightly below laboratory normal. This does not necessarily mean that you have a primary disorder or bone marrow dysfunction. at the same time it is worth investigating to see if there is any contributing factor. Possible causes of this type of finding include autoimmune disease, thyroid dysfunction, vitamin deficiency and there is also a segment of the population that consistently has a slightly low white blood cell count but otherwise remain very healthy. These individuals have a very mild benign leukopenia. this can sometimes be associated with racial or ethnic origin. you also mentioned that you have ankylosing spondylitis. As you know this is an autoimmune disorder and is possible that this might have something to do with a slightly low total white blood cell count. If you are otherwise remaining healthy without problems with recurrent infections, mouth sores, night sweats or lymph node swelling and this is something that can probably be followed conservatively. It would be reasonable for you to visit with a local hematologist to establish care and also for that hematologist to examine you and request some blood testing which might include a peripheral smear review. This review will help your doctor identify if your white blood cells appear normal under the microscope. while I cannot be certain it appears that you have a mild case of leukopenia which is benign. please visit with your local physician or hematologist to explore this further. Thanks again for sending your question. You also mentioned that you recently had the intrauterine device installed. There is no connection that I know of between this and changes in your white blood cell count. Dr. Galamaga

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Brief Answer: Followup Detailed Answer: thank you for the follow-up. there is no need to make assumptions about active infections. Your blood count is completely normal in my opinion. But this time I would not recommend getting any additional blood tests. Additional blood tests only seem to create confusion. Again I want to reassure you that there appears to be a normal blood count for you. please focus on continuing a very healthy active lifestyle. Good diet and regular exercise will continue to help you maintain an active and healthy immune system. Thanks again for sharing your healthcare concerns with us. I wish you all the best and continued good health. Dr. Galamaga

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