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Feeling fatigue, arm pain. Have low WBC, low absolute neutrophils. Chest xray clear. What is wrong?

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General & Family Physician
Practicing since : 2010
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I have low WBC, low absolute neutrophils, clear chest xray, fatigue, itching, aching arm and groin but can't feel any lumps ...
Posted Sat, 4 May 2013 in Blood Disorders
Answered by Dr. Sunil 4 hours later

Thanks for posting your query.

Low absolute neutrophil is considered when count fall below 1500/microL. Some populations like African Americans have normally low levels. There are many causes of low absolute neutrophils like leukemias, bacterial and viral infections, immune disorders etc. Sometimes infections can effect bone marrow causing low blood cells.

You should tell your history in little more detail and I can address your concerns better:
How long you have been experiencing these symptoms?
Have you experienced fever/diarrhoea in recent past?
Are you using or have used some medications in recent past? what are those drugs?
Have you any history of recurrent infections like frequents flu/cold?
What is the percentage of neutrophils in your test.

Waiting for your response.

Above answer was peer-reviewed by
Follow-up: Feeling fatigue, arm pain. Have low WBC, low absolute neutrophils. Chest xray clear. What is wrong? 3 days later
I went to doctor because I was itching all over for a few months and it had gotten bad enough that I had scratched the skin off in a few places. Doctor sent me for CBC and chest xray to rule out lymphoma. Have not seen all of the results yet but WBC was 2.3 and absolute neutrophils were 1. WBC had dropped over past 18 months from 4.6 to 3.3 to 2.3. Absolute neutrophils had also declined. WBC was 3.3 a few months after radioactive iodine treatment for thyroid cancer.

In addition to itching, fatigue level has been increasing for past several months (similar to fatigue before thyroid treatment but not as great). Thought I had been experiencing hip pain when moving/walking for the past few months. When I asked someone who had a hip replacement what the pain had felt like before replacement, she pointed out that I wasn't pointing to my hip. I realize now that this is my groin not my hip. Also have been experiencing pain in arm around elbow/inner arm (for the past 6 weeks or so) especially when reaching up and back, flexing arm, or lifting objects. Had gone to muscle pull due to lifting something heavy or repetitive action but don't know how it was caused. At this time I'm concerned because the pain seems to line up with lymph nodes in arm.

I have been losing weight very easily lately but nothing overly dramatic. I weigh less than I have in years but I did stop eating grains at the start of the new year. It has just been much easier to lose weight over past few weeks after very slow progress before that.

My chest x XXXXXXX didn't show anything (yeah!) and my doctor still wants me to see hematologist - it's been hard getting the appointment set up and in the meantime I'm very curious about what all of these things add up to ...

In answer to your other questions, no fever. I have major constipation (with 1 bout of diarrhea) for the past 4-6 weeks. No recent/recurrent infections. Medication: levothyroxine, calcium supplements. Thanks in advance for your input.
Answered by Dr. Sunil 6 hours later
Thanks for writing back in detail.

According to your description, there are few possible causes of your symptoms. First you should know in thyroid dysfunction you may frequently get moderate neutropenia (low neutrophils) thus decrease in WBCs.

But you should be screened properly for Lupus, Felty syndrome, leukemia and lymphoma. Detailed investigation is necessary to reach a diagnosis.

You are advised to visit your doctor and get abdominal ultrasound, CT scan, MRI, blood reports for antibodies for lupus (ANA, antiphospholipid,dsDNA), creatinine kinase, urinalysis, lymphnode biopsy and bone marrow aspiration.

After extensive investigation, one can exclude all possible diseases and may reach a diagnosis for further management.

Hope it helps you. If you have any further question I will be happy to help you.

Wish you good health.

Dr Sunil
Above answer was peer-reviewed by
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