Hello and welcome to HCM, A high monocyte count, low hemoglobin and low back ache can be due to same disease process or separate disease entities. Raised monocyte count is seen in both non-neoplastic and neoplastic disorders. Non-neoplastic disorders include chronic infections like malaria, leishmaniasis, tuberculosis, etc. These infections are more common in tropical countries and absent in temperate countries. Non infectious include multiple sclerosis, etc. Neoplastic diseases include leukemias. A peripheral blood examination and other relevant systemic investigations will help further. Low hemoglobin can occur due to dietary deficiency or due to decreased production of red blood cells in the bone marrow. Red cell indices - MCV, MCH, MCHC , RDW need to be done to know the cause of low hemoglobin. Low back ache can occur due to bad posture, skeletal muscle strain, or due to some pathology in the bones. In the presence of high monocytes and low hemoglobin, there is possibility of bone marrow involvement by leukemia. Consult a hematologist for further work up. Thanks and take care Dr Shailja P Wahal