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Low white cell count due to pnuemonia infection - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Infections
Answered by

General & Family Physician
Practicing since : 2009
Answered : 508 Questions
User :   My 23-year-old daughter suffered severe pneumonia at the beginning of last December, although her bloods, including white cell count appeared normal at the time. During a post pneumonia check-up at the end of December, her white cell count was low (I don't know how low!). She had another check a week ago, and it still appeared low. She recently had an HIV check, and that was normal, so no worries there. Is it common to have a low white cell count in the months following pneumonia, or could it be a sign of something else? One thing I should add is that she is taking various meds for bi-polar disorder, eg, Lamotrigine (Lactimel) and Citalopram. I'm very worried, and would be grateful to hear what you think, and should it be followed up by a Haemotologist?
Doctor :   Hi
User :   hi
Doctor :   reading Query
User :   ok
Doctor :   How old is she?
User :   23
Doctor :   Can you give me the latest lab values?
User :   sorry, I don't have them!
Doctor :   White cells , Platelets, Hemoglobin?
Doctor :   The normal WBC count is roughly between 5000- 11,000/mm3
Doctor :   This range is taken from normal persons with out any disease
User :   when she was admitted to hospital with pneumonia, all the values were normal. It's now only the white cell count that is low, but as I said, I don't know how low. Her consultant has written to the Haemotologists, so I guess it must be low enough to get an opinion about it.
Doctor :   if she falls in this range she is fine
User :   so, can some people's white cell count be lower than others. If the lab said it was low, then I guess she doesn't fall into that range!
Doctor :   If the counts are lower than lower limit of normal, that is 5000 then she evaluation
Doctor :   Are you with me?
User :   yep
User :   what can a low white cell count indicate please?
User :   can the meds she is on cause a low WCC?
Doctor :   A low white blood cell count usually is caused by one of the following: Doctor :   1. Viral infections that temporarily disrupt bone marrow function
Doctor :   2. Congenital disorders characterized by diminished bone marrow function
Doctor :   3. Cancer or other diseases that damage bone marrow
Doctor :   4. Autoimmune disorders that destroy white blood cells or bone marrow cells
Doctor :   5. Overwhelming infections that use up white blood cells faster than they can be produce
Doctor :   6. Drugs that destroy white blood cells or damage bone marrow
User :   obviously the pneumonia was an overwhelming infection, but would her white cell count now be back to normal 3 months are the event?
Doctor :   Lamotrizine can cause low white celll counts and platelets
Doctor :   Yes 3 mo after recovery her counts should reach her base line
User :   in that case, shouldn't the lamotrigine be changed for something else? she is repeatedly getting bronchitis - she has had 3 attacks of this and one of pneumonia in the past year!
User :   I should add that she seems quite tired a lot of the time
Doctor :   I will
Doctor :   ok
User :   i guess this must be caused by the low WCC?
Doctor :   Before coming to conclusion that her white cells are low, closely watch the numbers( white cells. platelets, hemoglobin)
Doctor :   Repeat the Complete blood count again
Doctor :   And do the peripheral smear to see any abnormal looking cells and also do differential count
Doctor :   If the levels are low then talk to MD and switch to different medicines
Doctor :   And then repeat the Complete blood count
Doctor :   If the count increases after stopping the medicines, then you can say the Lamotrizine causes the low count
User :   so, if it was something eg, cancer, would other blood values look abnormal, not just the WCC?
User :   and wouldn't this have been picked up on her recent FBC?
Doctor :   WHa is FBC/
User :   Full blood count
Doctor :   Bllod cancer present with low, normal high WBC
Doctor :   it causes bleeding
Doctor :   it has low hemogloibin
User :   sorry, did you say that blood cancer normally presents with a high WBC?
Doctor :   Then on peripheral smear, you will see abnormal looking cells
Doctor :   no it can present with any numbers
Doctor :   low or high or normal
Doctor :   Do the total count
Doctor :   peripheral smaear
Doctor :   I have 1 sec
Doctor :   I need more time
Doctor :   Thank you for consulting
Doctor :   Bye
Doctor :   hi
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