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Suggest treatment for low WBC count

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General & Family Physician
Practicing since : 2012
Answered : 3614 Questions
This is to obtain a second opinion. I am a 63 year old female. My Dr. is monitoring a chronic low WBC count. It is presently 3.5 K/microl. Lymphocytes are 48%. (ABS Lymphocytes are 1.7 K). My ABS Neutrophils are 1.3 K. These are all numbers slowly dropping from labs done in 2013. My Dr. did give me the option to follow up with a Hematologist for a likely Bone Marrow procedure or wait 6 months and repeat the CBC. Is it reasonable to wait, or would you recommend having a Bone Marrow test? Thank you for taking my question.
Posted Sun, 31 Aug 2014 in Blood Disorders
Answered by Dr. Shafi Ullah Khan 1 hour later
Brief Answer:
Mild Neutropenia but Better get evaluated

Detailed Answer:
Thank you for asking
Mild neutropenia or chronic nature can wait for 6 months but better would be to go for Work up and bone marrow with some other detailed work up like the following
Antinuclear antibody (ANA)
Rheumatoid factor (RF)
Serum immunoglobulin (Ig) studies
Liver function tests (LFTs)
Peripheral blood flow cytometry
T-cell gene rearrangement for T-cell clonality
PNH testing by high-sensitivity or fluorescent aerolysin (FLAER)–based flow cytometry

If infection / Fever then following labs too
Urine culture and sensitivity
Culture of wound or catheter discharge
Sputum Gram stain and culture
Stool for Clostridium difficile
Skin biopsy, if new erythematous and tender skin lesions are present

to sort out the cause. Age related WBC reduction is also a case. Let me explain it in a few headings.

-What causes neutropenia?
Neutropenia can be caused by some viral infections or certain medications. The neutropenia is most often temporary in these cases.
Chronic neutropenia is defined as lasting more than 2 months. It may eventually go away, or remain as a life-long condition. Some people are born with it (congenital neutropenia), and others develop it as young children.
In some people, neutropenia occurs in regular intervals or cycles. The neutrophil count is normal most of the time, but drops predictably about every three weeks. This is called cyclic neutropenia.
Another form neutropenia, Benign Neutropenia of Childhood, is most often discovered by accident, since the children are overall well. The ANC for a child with benign neutropenia may be below 500, but when they get infections, their body is able to push out neutrophils from the bone marrow into the circulating blood to raise the ANC and fight the infection.
Benign neutropenia is probably caused by the production of an antibody which attaches to the neutrophils and causes them to be destroyed in the circulation. There does not seem to be a problem with the bone marrow’s ability to make the neutrophils. This is sometimes referred to as autoimmune neutropenia since the body’s own immune system seems to make the antibody responsible for the ultimate destruction of the neutrophils.
This type of neutropenia usually goes away without any specific treatment within one to two years.

-How can neutropenia be treated?
There are medications that specifically stimulate the bone marrow to make more neutrophils. The most common medication used is called 11 Granulocyte Colony Stimulating Factor (11 GCSFI). It is most commonly given as a tiny injection under the skin, similar to the way diabetics take insulin. The neutrophil count usually only stays high while the person is taking the medication. Some people need to take the medicine every day, others may take it several times per week. By taking the GCSF regularly, most severe infections can be avoided.

-What should you watch for? Signs of infection include:
fever of >101 F (38.5 C)
pain, redness, or swelling of sores, joints, or lymph glands
redness, swelling or painful sores or tears in the mouth or genital area
You should report these symptoms to your doctor or nurse immediately (even if you notice them in the middle of the night).
If minor infections occur, they may be treated with antibiotics by mouth and/or topical applications to the skin. For more serious infections, antibiotics will need to be given by vein in the hospital.

-What can you do?
report symptoms (especially fever >101) promptly
the child should not play in moldy areas, in hay, ground mulch, or around manure from any animal
the child and caregivers should wash hands frequently, especially before eating
maintain vaccinations and well child/dental care
help the child keep a clean mouth and healthy gums
the child should shower daily. Keep baby’s diaper area clean. For girls who take bubble baths: no longer than 10 minutes (prefer showers)
don’t miss doses of prescribed medications
cook meats/fish/poultry/eggs thoroughly
avoid salad bars at restaurants
wash produce and fruit thoroughly
choose fruits and vegetables that can be peeled or thoroughly washed
if bedside humidifiers are used, cleanse them daily, and wash in dilute bleach weekly
change air/furnace filters monthly
have well water tested
consult MD before giving any herbals or supplements
clean scrapes and cuts with soap and water, followed by application of betadine or neosporin
don’t leave band-aids on longer than 24 hours
avoid suppositories or taking rectal temperatures
the child should not clean fish tanks or pet cages/litter box
It’s a good idea to keep outdoor play sandboxes covered
have pets vaccinated!
turtles and pigeons make lousy pets! Talk to your Dr. or nurse about pets.

Nut shell, there is no harm in getting evaluated for labs. I hope it helps.Take good care of yourself and dont forget to close the discussion please.
May the odds be ever in your favour.
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