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Dr. Andrew Rynne

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What causes lack of appetite and sudden weight loss?

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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1465 Questions

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Posted on Wed, 25 Apr 2018 in Blood Disorders
Question: visit two times to hematologist. Dr told wait and watch .One Dr. suggested for Flow cytometry to ruled out possibility of CLPD and other wait and watch. I am totally confused and too much tensed .
NO FEVER NO WEIGHT LOSS NO APPETITE LOSS ONLY LEG PAIN .NO TOO MUCH TIREDNESS ,NO BODY RASHES
PLEASE SUGGEST WHAT TEST I WILL DO TO RULED OUT BLOOD CANCER OR ANYTHING . CRP TEST NEGATIVE
doctor
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer:
Flow cytometry can be done

Detailed Answer:
Hi
Thanks for your query.

Your lymphocytes are indeed high and persists >5 weeks. Though one of the smears mention reactive lymphocytes, since there is no reduction I would recommend flow cytometry for CLPD. It may be an incidental manifestation of CLL or chronic lymphocytic leukemia.

However, even if it is confirmed as CLL, no treatment is required now as there is no symptoms and Hb and platelets are normal. Only regular monitoring will be required. You can continue to lead healthy life for many years.

Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 31 minutes later
I am very much tensed about CLL or CLPD .what is the procedure for flow cytometry test .It is just taking blood from vain and ckd in lab .or something other's Whether I will go to big hospital or wait for some time and again ckd CBC

Is there Any medicine to decrease the level of lymphocytes or diet to control
doctor
Answered by Dr. Indranil Ghosh 0 minute later
Brief Answer:
Yes it is the blood test

Detailed Answer:
Please don't worry so much now. We have a suspicion which we need to rule out. And even if it is diagnosed nothing needs to be done immediately as it is a very indolent disease.

I would suggest get the flow cytometry now. You can get it done from SRL lab as CLPD panel. Then you can share the report here. Otherwise go with the hematologist recommendation.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Indranil Ghosh 10 days later
AS per your advice ,carried out FLOW CYTOMETRY TEST . REPORT ATTACHED .
ALSO CARRIED OUT CBC TEST. TLC COUNT DECREASED AND LYMPHOCYTES ALSO DECREASED. PLEASE ADVICE ME WHAT I WILL DO . ANY FURTHER TEST OR HERE STOPS AND WAIT. SIR MY SOME WELL WISHERS SUGGESTED TO GO MR M B AGRAWAL XXXXXXX AND SOME ONE SUGGESTED TO WAIT FOR FEW MONTHS AND AGAIN CARRIED OUT CBC .
SIR I AM TENSED AND GET CONFUSED . SIR I AM STAYING IN XXXXXXX PLEASE ADVICE ME
doctor
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer:
This is suggestive of monoclonal B Lymphocytosis

Detailed Answer:
Hi
Thanks for followup.

This report is suggestive of monoclonal B lymphocytosis (MBL). This is like a precursor stage for CLL. If Monoclonal B cell goes above 5000/ul (now 2250), it will be classified as CLL. Overall, 1-2% of such patients per year progress to CLL. Even if it is CLL, it may not require treatment immediately.

Obviously, there is no scope of treatment now. We just have to wait and watch. A CBC every 3 months and if WBC increases then repeat CLPD panel to quantify monoclonal B cells.

You can very well consult Dr MB XXXXXXX he is a XXXXXXX hematologist but I don't think advice would differ much.

Overall, there is nothing to worry at present. You will continue to lead a healthy life.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 22 hours later
Thanks sir for explaining the facts in details .To some extent I got relief after getting your reply.
As per report mentioned as suggestion for some further test like molecular genetics and cycline d1 /BMT
Whether at present BMT is required or wait for 3 months after CBC TEST .If BMT is required at any time where it is best because all this vital & costly test should be carried out in reputed clinic/hospital under guidance of good pathologist.By seeing that report only any SPECIALIST DR will give their comments /treatment steps.
At present any supporting medicine or diet precautions or yoga please advice .Again thanks sir for moral boosting
doctor
Answered by Dr. Indranil Ghosh 12 hours later
Brief Answer:
No these tests not required now

Detailed Answer:
At this point genetic testing or bone marrow aspiration not required. Only blood tests to monitor are fine. Bone marrow required only if we decide on treatment, ever.
No specific dietary restriction. Exercises and yoga are in general good for health but no relation to this condition.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 35 hours later
OK SIR .I will follow your advice .But one confusion arises why blood test CBC result will come fine or steady without any treatment /taking any medicine .How WBC COUNT/LYMPHOCYTES COUNT/ MONOCLONAL B CELL COUNT will reduce from present mark . NO infection as CRP test is negative .
Attaching my BLOOD DATA record carried in different two -three LABS.As per that record WBC COUNT /LYMPHOCYTES COUNT have INCREASED tendency .

Thanks sir for right guidance
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Count will not reduce

Detailed Answer:
Actually count will not reduce as this is an uncontrolled proliferation of lymphoid cells. It can increase gradually. Around 1-2% progress to CLL per year. But just progression to CLL is not enough for starting treatment. If it causes weight loss fever, bulky lymph nodes, low hemoglobin or platelets, then only to start treatment. Treating earlier than this doesn't improve the outcome in any way.

In a nutshell, this wbc count doesn't need treatment but it will persist or slightly increase over time.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 48 hours later
This is an uncontrolled proliferation of lymphoid cells. It can increase gradually. Around 1-2% progress to CLL per year. VERY REMARKABLE TRUTH . & UPSET TO SOME EXTENT.At this stage what I will do ? Any precautionary action for not weight loss /not reduce hemoglobin or platelets.

Treating earlier than this doesn't improve the outcome in any way. ok sir .Now I will wait for three months for next CBC .
doctor
Answered by Dr. Indranil Ghosh 8 hours later
Brief Answer:
No precautionary action required

Detailed Answer:
It may not progress to CLL in your life time and even if it does, it can take long time. And treatment of CLL is there.
However, nothing can be done at this point to prevent progression. There is only one treatment for MBL around the globe, wait and watch.
Above answer was peer-reviewed by : Dr. Yogesh D
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