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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Does An Elevated Absolute Lymphocyte Count Indicate?

I am a medical student with a love for Heme/Onc...I am certain that my father-in-law has CLL based on his blood work from the past 2 years. He has had a consistently elevated absolute lymphocyte count for almost 2 years now ( 8.0 K/uL over the past year), relative lymphocytes between 67-69%, persistent mild thrombocytopenia (114 K/uL), and smudge cells present on his peripheral smear. His doctor has not diagnosed or referred him out, and when I asked my father-in-law to go back and push for his doctor to take a more in depth look at his blood work, his Dr. simply replied, Your results show some minor changes in the platelet count and white blood count. I have reviewed these with Hematology and their opinion is to simply track these counts over time as they are not significantly off. If you have any questions or concerns, please feel free to contact our office. I don t understand this at all. Is there something I m missing?
Wed, 10 Jan 2018
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Pathologist and Microbiologist,  's  Response
Hello. Thanks for asking on healthcaremagic. A chronic elevation of absolute lymphocyte count above 5000/cumm raises strong suspicion for CLL. However since the lymphocyte doubling time is high, means the stage is quite indolent the physician might not want to treat it as yet. It is important to monitor the counts to look for sudden increase or transformation to CLL/PLL or PLL. However you can go in for flow cytometry to confirm your diagnosis. Like CD5, 23, 19 will be positive. Malignant lymphocytes will be monoclonal and all will display either kappa or lambda light chains on surface. Reactive lymphocytes will display kappa lambda light chains in mixed proportions. Hope you got it. Thanks. Though they might not want to treat it yet, no harm in confirming the diagnosis. Remember chronic leukemias are very slow growing and incidental findings unless there s a transformation.
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What Does An Elevated Absolute Lymphocyte Count Indicate?

Hello. Thanks for asking on healthcaremagic. A chronic elevation of absolute lymphocyte count above 5000/cumm raises strong suspicion for CLL. However since the lymphocyte doubling time is high, means the stage is quite indolent the physician might not want to treat it as yet. It is important to monitor the counts to look for sudden increase or transformation to CLL/PLL or PLL. However you can go in for flow cytometry to confirm your diagnosis. Like CD5, 23, 19 will be positive. Malignant lymphocytes will be monoclonal and all will display either kappa or lambda light chains on surface. Reactive lymphocytes will display kappa lambda light chains in mixed proportions. Hope you got it. Thanks. Though they might not want to treat it yet, no harm in confirming the diagnosis. Remember chronic leukemias are very slow growing and incidental findings unless there s a transformation.