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Had reaction to statins. Had prostatitis and undergone back operation. Having arthritis. Advise?

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Dr. Brenes-Salazar: You earlier responded to my question in which I had a 16 wbc, with a 77% lymph and 17% neutrophils. Two subsequent tests were taken and they resulted in 77% lymph and 18% neutrophil, and then 70% lymph and 25% neutrophils. (I got off fish oil). I went to a hemotologist and received a full work-up. He thought I might have CLL, but the tests seem to show that I may have proteinuria. Here's what the labs show: Protein, 24 hr urine, mg/24hr     128.7 mg/24hr     30.0 || 150.0
Protein, total, random urine     7.8 mg/dL     0 || 15.0
Immunofixation, urine interpretation     Comment     N/A
Albumin, UPE     100%     N/A
Alpha 1 globulin, UPE     0%     N/A
Alpha 2 globulin, UPE     0%     N/A
Beta globulin, UPE     0%     N/A
Gamma globulin, UPE     0%     N/A
IFE and PE, serum note     Comment     N/A

The absolute neutrophils were contstant but the lymphs went down (around 12 to 10 for lymphs 10 and neutrophils 3).

The question I now have is whether the high wbc over the last three years (from 12 to 14 to 15 and back down to 14) could be from proteinuria --- and does that rule out cll?

I had protatitis about 6 years ago (and now take avodart), which helps. My PSA is 1.7 and I can urinate relatively easy.

I haven't gotten the result of a peripheral smear yet, but from the urine tests (I had to collect 24 hours), there doesn't appear a problem (I think) with some sort of globulin leakage (but I'm not a doctor).

I feel great --- and ride a bike about 50 miles a week. I sleep well and have no outward signs or feelings of illness. But I wanted another opinion on this.

Thanks for your anticipated comments. Regards, M

Posted Thu, 17 Oct 2013 in Blood Disorders
Answered by Dr. Jorge Brenes-Salazar 5 hours later
Brief Answer:
Proteinuria unlikely reason

Detailed Answer:
dear mr XXXX

good to hear from you again. I am glad that you are completing the workup. the proteinuriain 24 hours is really not significant it is less than 300 mg per day. that is unlikely to explain the wbc elevation chronically. i like the fact that the specialist is trying to rule out chronic causes of elevated wbc such as multiple myeloma ( by the way the tests are not consistent with that) and CLL. We will have to wait for the results of the peripheral smear, but if there continues to be a diagnostic doubt, it may come to diagnostic bone marrow biopsy which would not be unreasonable.

keep me posted, truly yours

Dr Brenes Salazar
Above answer was peer-reviewed by
Follow-up: Had reaction to statins. Had prostatitis and undergone back operation. Having arthritis. Advise? 16 minutes later
Thanks for getting back to me about this. Looking at the urine tests, don't the Alpha, Beta and Gamma globulin tests (all 0%) indicate inconsistency with CLL as well? I have always had what I thought was a heightened and positive reaction to anti-inflammatories (NSAIDs like ibuprofen, which always seemed to work extremely fast). Since I quit the fish oil, the WBC has shown a decline in lymphs and an increase in neutrophils (more toward normal). This makes me wonder whether some sort of inflammatory event is going on and whether I've somehow "activated" the lymphs with the Omega 3's. As I mentioned earlier, I had many points of arthritis, but they seemed to have disappeared with the fish oil. I'm feeling some of them again as the fish oil wears off.

Obviously the peripheral smear will address this --- and I should know on Friday. Still, I wonder what's going on. I should have gone to medical school like my father told me. Unfortunately I rebelled and became a lawyer instead.

Thanks for your analysis.

One thing I forgot to add: This was listed on the results, too.

M-Spike, random urine, % Not Observed

Not sure what this means.
Answered by Dr. Jorge Brenes-Salazar 3 hours later
Brief Answer:
No multiple myeloma

Detailed Answer:

that means that there was no evidence of the typical protein excreted in the urine in multiple myeloma, thus it is another argument against such diagnosis

best regards
Above answer was peer-reviewed by
Follow-up: Had reaction to statins. Had prostatitis and undergone back operation. Having arthritis. Advise? 37 hours later
Dr. Brenes Salazar: Sorry to bug you again, but I was able to download the full test results.

MCV 92.1 fL 80.0 || 97.0
HGB 15 g/dL 13.5 || 18.0
HCT 46.2% 39.0 || 51.0
RDW 14.1% 11.5 || 14.5
MCHC 32.5 g/dL 31.0 || 36.0
MCH 29.9 pg 26.0 || 32.0
PLT 165 x 10^3/uL 140.0 || 440.0
LY # 10.5 x 10^3/uL 0.6 || 4.1
Neu # (ANC) 3.6 x 10^3/uL 2.0 || 7.8
WBC 14.6 x 10^3/uL 4.1 || 10.9
RBC 5.02 x 10^6/uL 4.2 || 6.3
LY % 72% 10.0 || 58.5
Neu % 24.7% 37.0 || 92.0
MID % 3.3% 0.1 || 24.0
Hepatitis B core antibody, total Negative N/A
Hepatitis B surface antigen Negative N/A
Hepatitis B surface ab, qual Non Reactive N/A

MID # 0.5 x 10^3/uL 0 || 1.8
Sedimentation rate, Westergren 2 mm/hr 0 || 30.0
Direct antiglobulin test Negative N/A
Thyroxine (T4) 6.9 ug/dL 4.5 || 12.0
TSH 2.9 uIU/mL 0.45 || 4.5
T4, free 1.12 ng/dL 0.82 || 1.77
Beta 2 microglobulin 1.4 mg/L 0.6 || 2.4
A/G ratio 1.7 0.7 || 2.0
LDH 200 U/L 0 || 225.0
IgG, quant 857 mg/dL 700.0 || 1600.0
IgM, quant 165 mg/dL 40.0 || 230.0
IgA, quant 132 mg/dL 91.0 || 414.0
Gamma globulin 0.8 g/dL 0.5 || 1.6
Beta globulin 0.9 g/dL 0.6 || 1.3
Alpha-2 globulin 0.5 g/dL 0.4 || 1.2
Alpha-1 globulin 0.2 g/dL 0.1 || 0.4
Globulin 2.5 g/dL 2.0 || 4.5
M-spike, serum Not Observed N/A
Immunofixation, serum Comment N/A
Chemistries Lab result note Comment N/A
Albumin, SPE 4.2 g/dL 3.2 || 5.6
Leuk/Lymph, panel result ADL N/A

Three questions:
1. I think this shows fairly good results except for the lymphs. Is this right?
2. Does the last entry, "Leuk/Lymph, panel result ADL N/A" mean "activities of daily living," meaning "Go about life and don't worry too much?" Or does it mean something like, "You're okay for awhile, but we'll think about it?"
3. Also, where there is a "comment", what does this mean? Does it mean that there is a longer description somewhere?

The internet is great for accentuating the ups and downs of all this. Next lifetime I'll come back as a tree. Thanks. M
Answered by Dr. Jorge Brenes-Salazar 27 hours later
Brief Answer:
Good results

Detailed Answer:
Dear Mr XXXX:

Thanks for the specific results which I have reviewed.

1) I agree, the only issue continues to be elevated WBC with lymph predominance. Otherwise everything looks great

2) The ADL abbreviation in such context may mean acute derived leukemic cells, probably was not ordered or available since the peripheral smear was to be obtained. As yourself, I am more familiar with ADL to represent activities of daily living

3) Indeed, when there is a comment is because further description of the numeric value is found elsewhere, or there is a caveat about the interpretation of the test (eg. for example a high potassium in a hemolyzed specimen, the lab comments that the specimen was hemolyzed)

Let me know if I can be of further assistance, best regards,

Dr Brenes-Salazar
Above answer was peer-reviewed by
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