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Had abdominal swelling, abdominal pain and tenderness. Report showed severely enlarged liver. Suggest

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I recently went to the emergency room with abdominal swelling and abdominal pain and tenderness - mostly on my right side right under the rib cage, but pain and tenderness on my left side under the rib cage as well. A CT scan found a severely enlarged liver (23 cm) with diffuse fatty infiltration, but no other abnormalities (normal spleen, normal lymph nodes, no fluid). But I am most scared by my blood results, which were mailed to me today. They show slightly low hemoglobin (10.6) and hemoocrit (32.7), a slightly high mono count (12. 2), but - big scary one for me - immature granulocyte count of 1.1 (normai is .1 - .3) and immature granulocyte absolute count of .10 (normal is .01 - .03). Everything else was in normal range except for high (45) ALT and low potassium (3.4). I know immature granulocutes and enlarged liver both can be associated with leukemia. I called the hospital to see if they had done any further testing of the blood to rule that out and they had not. The nurse told me they would not run further tests unless the CBC warranted it. I have an appt with a liver specialist two weeks from now, but am freaking out about the blood results and the possibility of leukemia. Could the inflammation of the liver by itself cause the high immature granulocyte count? I do have fatigue, and mild shortness of breath when I climb stairs, but these are long-standing problems and I am, admittedly really out of shape. No fevers, night sweats, or anything of that nature. Help calm me down if you can.
Posted Tue, 28 May 2013 in General Health
Answered by Dr. Michelle Gibson James 55 minutes later
HI, thanks for using healthcare magic

It is understandable to be concerned.

The hemoglobin level is low but fortunately not significantly so- the female range in most labs is from 11 so a value of 10.6 is just below the normal and would not be considered concerning.A low hemoglobin is usually associated with a low hematocrit. The hematocrit is the number of red blood cells in the blood.

Leukemia occurs when there is an marked increase in the white cell count (WBC in your results) , this would be very very high. Because the body is over producing the white cells, there would also be significantly suppressed production of other cells. In other words your hemoglobin and platelets would be very low, in most persons the Hb would be in the single digits and the platlets in either double digits or low hundreds.

The monocyte and granulocyte form part of the white blood cell count. The white blood cells are responsible for fighting infections and some other illnesses. There are different types of white blood cells that have different functions. The monocytes are responsible for transforming into substances called macrophages.

Granulocytes are white blood cells with granules inside. Less than 2% immature granulocyte is normally considered insignificant.

The presence of the increase immature counts is concerning but it is not at the level that can presently indicate leukemia especially if the white cell count , the primary marker of leukemia is not very high.

You are unlikely to have leukemia if the WBC is not high but to ease your mind you can visit your GP for a repeat complete blood count.

I hope this helps , feel free to ask any other questions
Above answer was peer-reviewed by
Follow-up: Had abdominal swelling, abdominal pain and tenderness. Report showed severely enlarged liver. Suggest 1 hour later
Thank you. My WBC was in the normal range (9.1) and the platelets also were normal and actually on the high end of normal (382), so I do feel much better hearing your response. I am curious, though, if the inflammation in the liver, which appears to be due to fat, could be the cause of the higher-than-normal immature granulocytes. I don't appear to have any infections and I am gaining weight instead of losing it, so I just wonder if severe inflammation can be the culprit. Could it be that?
Answered by Dr. Michelle Gibson James 4 hours later

I am glad you feel a little better, as mentioned earlier in leukemia because the bone marrow is in overload making white blood cells there is suppression of both red blood cells and platelets.

Simple inflammation with no infection is not normally associated with the presence of immature granulocytes.

It usually requires the presence of at least a mild infection, the inflammation as you stated , would have to be very significant and it is possible that the inflammation of the liver is significant.
I think it may be best to repeat the full blood count to determine if there is persistent elevation

Please feel free to ask anything else
Above answer was peer-reviewed by
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