Brief Answer:
Considerations

Detailed Answer:
thank you for sending the question.

From the information you have provided it looks like your mother has a progressive degree of anemia with eight slowly increasing total white blood cell count. At the same time it appears that her platelet count has slowly declined as well. At this time it is important for us to rule out a primary bone marrow disorder which might be contributing to some of these particular laboratory findings. There are number of disease processes within the bone marrow which can lead to these findings on the complete blood count.

I agree that vitamin B 12 supplementation as reasonable as her vitamin B12 level was borderline but it does not explain the elevated white blood cell count. It appears that her total lymphocyte Count is elevated as well so we must rule out entities including chronic lymphocytic leukemia.also we must rule out other disorders which can disrupt normal bone marrow function.

I think it is important for you to visit with a local hematologist who can review some of the laboratory studies that you have provided. It is extremely important to obtain old laboratory studies including those done several years ago in order to help determine when the blood count started to change. This might require some additional work but would be very helpful to the hematologist.

The hematologist me request some additional laboratory testing or possibly may recommend a bone marrow biopsy. Bone marrow biopsy is a very simple test which can tell us quite a bit of information when a patient presents with abnormal blood counts. I think a bone marrow biopsy may be a reasonable next step in the evaluation of why the blood counts are abnormal.

please make an appointment with a local hematologist for further discussion. I did review the additional laboratory studies and I do not see any other signs of obvious disease process is going on.

Thanks again for sending the question. Please let us know if you have any additional specific concerns related to your primary question.

Sincerely,

Dr. Galamaga

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Brief Answer:
Follow

Detailed Answer:
hello again,

I am not suggesting this is actually acute leukemia but it is possible she might have what we call chronic leukemia. This is a very slow process which can evolve over many many years. She does have a moderate degree of anemia with hemoglobin low again at 9.5. this may represent a primary process within the bone marrow.for this reason I think it is very important that you review her laboratory tests with a local hematologist in order to determine if additional studies are needed including possibly a bone marrow biopsy.

again the laboratory studies also suggest a mild degree of vitamin B 12 deficiency. If she continues with B12 supplementation this may help to have a positive impact on her blood counts.

I am very interested to know some of the details of the additional consultation you have had since you were last update. Please share that with me when you have a chance.

Sincerely,

Dr. Galamaga

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Brief Answer:
Follow up

Detailed Answer:
thanks for the additional information.

The results of the CT scan as well as the laboratory test are suspicious for possible lymphoma. I think you will need to discuss this with a local hematologist and talk about additional workup which might include a bone marrow biopsy or possibly a lymph node biopsy if they think that is really needed.

At the same time I want to reassure you that we have increasingly effective treatments for lymphoma which will hopefully help keep lymphoma under Control for a very long time.

Again additional diagnostic studies need to be done in order to confirm the diagnosis.

Thank you again for sharing your health care concern. Regarding billing and additional questions I really am not sure how that works on your side. If you do have questions please submit that to the website and they will help guide you in seeking our assistance with any follow-up questions.

Dr. Galamaga

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