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Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia?

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Practicing since : 2002
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I have been diagnosed with chronic neutropenia since 2006, I don't get sick thank God, other than the usual colds like most people. I had a cbc on 3-12-13 and here is what was out of range, WBC 3.8 ref. 4.3-11.0, Neuts 33 ref. 36-76, Lymphs 55 ref. 20-45, and here is what was in range, RBC 4.11 ref 4.00-5.40, Hgb 13.4, Hct 38.8, MCV 94.5, MCH 32.5, RDW 12.7, Plt 223, The following were done manually Neuts. 33 ref. 36-76, Lymphs 55 ref. 20-45, Man Bands 2 ref. 0-11, monos 9 ref 3-12, Eos 0, Baso 1 ref 0-1, Neut Abs 1.3 ref 1.3-7.4, Eos 0, RBC Morph normal, Plt normal. My concern is the high Lymphocyte count because I know that could rise with Leukemia, I also know a manual is more accurate than a Auto Diff. Now my last Auto Diff was Lymp 50% and the Neuts were 42%. Can you please clarify this for me, ARE THE LYMPHS HIGH BECAUSE THE NEUTS ARE LOW AND IT HAS TO BALANCE OUT, is it the Absolute Value that is more important than the %. I also had a myelodysplastic syndrome could not be ruled out, everything else was ok espect for my usual low white count due to Neutropenia, and there were no circulating blast. I just repeated the cbc with a manual differential today. I also was told a lymphocyte count should be between 30-40 for someone my age, I am 55 and otherwise in good health. I exercise by running and light weight lifting and eat healthy, I do not smoke or drink. I have been so very worried about this. At what percentage should I be concered about a high lymphocyte count, could this be a slow growing leukemia? I have been so worried about this. I would greatly appreciate your honesty and expertise opinion.
Posted Wed, 8 May 2013 in Blood Disorders
Answered by Dr. Robert Galamaga 7 hours later
Hi XXXXXXX thank you for sending your question.

Your question is a very good one and I will provide you with some information and recommendations.

I completely understand your concern regarding the lymphocyte count. In your case however, it is more important to look at the absolute lymphocyte count as well. You're absolute
lylymphocyte count is within a normal range. You have a slightly increased percentage of lymphocytes which does not necessarily reflect a major problem.

In addition your hemoglobin and platelets are within normal limits. This also goes against any type of leukemia.

I realize you have a chronically low white blood cell count. It does appear to be relatively stable and your neutrophils are not so low that your immune system can't fight infections.

It appears that your doctors have done a good job in monitoring. The complete blood count done in about six months and that would be reasonable.

Please let me know if you have any additional specific concerns.


Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia? 15 hours later
Hello again and thank you for your response, here are the results of my test I received today from yesterdays blood draw, there was Large Platelet Present on the Manual Diff so the doctor ran another blood test today STAT with a Manual Diff and it showed Platelet Morph Normal today, only on yesterdays draw it showed the Large Platelet. I do know that a large Platelet is a immature cell is it normal to have it one day and not the next, was my body just making new cells? Here are the results from both test,
WBC 4.1, RBC 4.21, Hgb 13.5, Hct 39.7, MCV 94.2, MCH 32.1, MCHC 34.1, RDW 13.0, Plt 227, Manual Diff Neuts 51, Lymphs 39, Monos 5, Eos 3, Eos Abs Man 0.1, Man Bands 2, Neut Abs Man 2.2, RBC Morph Normal, PLT Large Platelet Present.
Now here are the Labs from today's draw,
WBC 3.1, RBC 4.36, Hgb 13.7, Hct 40.6, MCV 93.2, MCH 31.3, MCHC 33.6, RDW 12.8, Plt 216, Manual Diff Neuts 42, Man Bands 0, Lymphs 54, Monos 4, Eos 0, Baso 0, Neut Abs Man 1.3, Eos Abs Man 0.0, RBC Normal, Plt Normal, the only 2 things out of range were WBC 3.1 the low range being 4.3-11.0 and Lymphs 54 range 20-45. I have had a lot of PBS and none of them have ever showed Large Platelets so could this have just been a one time thing and hopefully nothing to be concerned about? I am not worried about the high Lymphs cause I see they were 39 and looking back on past test they have highs and lows, same with my white count. The Large Platelet was something never seen before so if you could comment on this I would greatly appreciate it. Thank you again for being most helpful,
Answered by Dr. Robert Galamaga 12 hours later
Hello again and thank you for the follow up.

I am not concerned at all about the finding of the large platelet on your blood count. This is something that can be seen sporadically from time to time without any significant implications.

If your smear showed many of these types of platelets this might be something to look into but at this point I am not concerned at all. Again I don't think you need any additional blood tests for at least six months.

Thanks again for sending your question. Please let me know if you have any additional specific concerns.

Dr. Galamaga
Above answer was peer-reviewed by
Follow-up: Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia? 13 minutes later
You said if my smear showed many types of large platelet cells it could be something to look into the report did not say how many it only said present how do I know how many are or were present? Thank you for responding.
Answered by Dr. Robert Galamaga 8 hours later
If there were many it would have been noted. Not something to worry about at all at this time. Also the repeat CBC with no evidence of large platelets supports this.

All the best to you.

Dr Galamaga
Above answer was peer-reviewed by
Follow-up: Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia? 2 days later
Thank you again for your respone. You did say large platelets could happen sporadically I am just wondering what causes that to happen sporadically? As I mentioned before I have never had that on any of my cbc's and thankfully the cbc done the very next day didn't show large platelets. If it was something serious would it have likely shown up on the next days cbc? Again what causes it to happen sporadically? Thank you very much for your help.Hello, I have on other question regarding my CBC. After reviewing it further I see the Pathologist made a revised report. My lymphocyte count on the Manual Diff was 39 and my white count was 4.1, that would have made my ABS LYMP at 1.599. Now then on the revised report by the Hemapathologist my ABS LYMP is 1.8, which would mean I had more than 39% lymphs. I was concerend in my previous question about my lymphocyte count being to high at 55, normal 20-45. So then what was my real percentage of lymphocytes, he only had the Absoulte Value, 1.8 and white count 4.1. I was also told that the older you are the less lymphocytes you should have, I know a high lymphocyte count could be from leukemia. Sorry I also left out the Hemapathologist revised my Neutrophil count as well, it was 51% and Abs Neuts were 2.2, the Hemapathologist revised the report to be Absolute Neuts at 1.8 which would drop my % of Neut from the 51%. So he revised the Abs Lymp to 1.8 and Abs Neut to 1.8 and did not change the WBC being 4.1. What does that make my Lymp % and I so very worried it is to high and that I could have leukemia? My lymphs always seem to be high? Again I am 55 years old and I have been told that as you age the lymphocyte count should be lower. Sorry to keep sending you questions, but I keep looking at these reports that are driving my crazy, I don't understand. I looked at my CBC that was done the day after and my Lymphs were 54% normal being 20-45%, the Absolute count was 1.5 normal being 0.7-3.1, do I or don't I have to many Lymphs, I am very confused. My WBC on that day was 3.1 and Neuts were 42% and ABS Neuts were 1.3, normal being 1.3-7.4. I hope you can please clarify this for me. I can't keep calling my doctor for these questions because he just doesn't have the time to answer them all and I gon't go back for 6 months. I am worried if my Lymphs are to high? This CBC was also reviewed by the same Hemapathologist that reviewed the last one the day before and there were no revisions made by him. RBC 4.36, Hgb 13.7, Hct 40.6 everything else within normal range, except WBC 3.1, Lymphs 54%, Neuts 1.3 borderline. The Hemapathologist did comment Borderline Absolute Neutropenia without abnormal cells. Could it still be a low grade evolving MDS with the Lymphs being 54%?
Thank you so much for your help.

Answered by Dr. Robert Galamaga 2 hours later
Thank you for the follow up question.

Occasionally a giant platelet might form sporadically or may be released prematurely from the bone marrow. This is a common finding in patients with myelodysplasia where we see sometimes many giant platelets on a smear. Even in a healthy person a rare giant platelet may be seen from time to time.

Again I want you to realize that I do not see any concern on your complete blood counts. The relative percentages in absolute numbers that you're talking about are not in any type of pathologic range. I would not look at these tests anymore and reassure yourself that checking your blood test again in a few months would be a reasonable follow-up. Otherwise you will end up generating worry and anxiety for no reason. Thanks again for sending your question. Let me know if there's anything else specifically that I can help you with.

Dr Galamaga
Above answer was peer-reviewed by
Follow-up: Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia? 1 hour later
So in MDS you can have a giant platelet mine was large is that the same as giant? And you said it is a common finding with MDS. How common is it to find it in healthy people, please be honest,is it rare? At this point I think I would like another WBC and low Neuts and now this large platelet is begining to sound more and more like MDS. So I did so more research and found Large Platelets could be from MDS, they don't have to be Giant. You did say they can be sporadiac and that was the first time seen on mine. From what I read it is rare to find them in a person who does not have MDS? It appears more and more to me I have MDS. Sometimes I feel like the doctors just are not honest with me because they really don't do anything until you have symptoms, I would appreciate your honesty.
Thank you for your responses.
Answered by Dr. Robert Galamaga 57 minutes later
Hello again.

There is no indication for bone marrow biopsy yet this time. I realize that you want this for some type of peace of mind but I am convinced that even if you get a repeat biopsy it would lead to more confusion and anxiety. Please understand that there is no rush to perform additional bone marrow biopsies or blood tests at this time. I think you're hematologist would agree.

I have no other recommendation at this time other than to wait at least three or six months to have a repeat complete blood count.

Dr Galamaga

Above answer was peer-reviewed by
Follow-up: Diagnosed with chronic neutropenia. Found high lymphocyte count. Is this slow growing leukemia? 1 hour later
Can you please tell me how common it is to see large platelets in someone who does not have MDS, from what I understand it is not common. Why do you think a bone marrow would produce more anxiety, do you not think with my test results would be normal based on my CBC findings. When I had the bone marrow done last year in XXXXXXX 2012, my platelets appeared normal, I am wondering now if this is MDS if it is progressing. I am going to contact my Hematologist tomorrow but I would appreciate your insight on the matter. I am not clear on what you are refering to when you say "Occasionally a giant platelet might form sproadically or may be released prematurely from the bone marrow". Then you said it is a common finding with people with MDS. What I would like to know is if someone has MDS will you always see Large Platelets on the Periphal Smear or just "Occasionally". When you say occasionally I am not sure if you mean "Occasionally" on a healthy individual or "Occasionally" on someone with MDS? Again I have had several Periphal Smears and this is the one and only time it was mentioned. Can you please clarify if this is something that would be seen all the time with someone with MDS or could happen "Occassionally"? Just want to make sure you are understanding my question and that I am understanding your answer. Thank you again.
Answered by Dr. Robert Galamaga 8 hours later
Giant platelets are not always seen with MDS.

Thanks again.

Dr G
Above answer was peer-reviewed by
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