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What Causes Low WBC Count And Elevated NRBC Count While Experiencing Headaches And Breathlessness?

Posted on Thu, 24 May 2018

Question: Low White blood cell count elevated NRBC. White blood cell count dropping over two years. I have had 7 CBC blood tests over two years. My white blood cell count has dropped over that time. It is at 3.1 and was at 7.2. During those two years I had 6 cat scans. Additionally, my last CBC revealed an elevated NRBC(Nucleated Red Blood cell count) of 0.1. I am very worried about this and would like to know possible causes for this. I get headaches,night sweats once in a while and shortness of breath. I am 21 years old and average height and weight.No other previous health problems.

Answered by Dr. Saddiq Ulabidin (2 hours later)

Brief Answer:
May need bone marrow biopsy

Detailed Answer:
Hi! Welcome to Healthcaremagic. Thanks for sharing your concerns with us. We will try to help you in best way possible. First of all it's sad to know what you had been going through lately.

Based on the history you have shared, it's good that various CAT scans haven't revealed anything significant and that is a good sign that even if some problem exists in blood synthesis it hasn't travelled to any tissue and is manageble.

At this stage, other blood tests like LDH, ESR, CRP, Serum Calcium and Alkaline phosphatase as well as peripheral films would have been done and are part of baseline workup in the case you have mentioned.

The increasing NRBC and decreasing white cells both indicate problem related to bone marrow and can be due to increased demand like in chronic low oxygen or high altitude conditions or decreased precursors or raw material for the process like iron, B12, Folate etc and their levels will also be needed to be checked.

However the most specific test in my opinion would be a bone marrow aspiration biopsy or even a trucut biopsy and hematologist is the right person to be consulted in this regard.

Wishing you a speedy recovery. Hope this has answered your question. If you have any more questions please feel free to ask. Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Saddiq Ulabidin (1 hour later)

Hello,
Could these tests possibly be related to anything other than blood disorders? Neurological disorders or autoimmune disorders?

Thanks for the help

Answered by Dr. Saddiq Ulabidin (15 minutes later)

Brief Answer:
Autoimmune disorders may cause this

Detailed Answer:
Hi! Yes many autoimmune disorders like autoimmune hemolytic anemia, some forms of hypothyroidism may cause it but generally other auto immune disorders like SLE etc may also cause marrow involvement or due to exaggerated immune response white cells over production or marrow suppression due to over production may occur.

Nervous system disease doesn't commonly cause this blood picture unless coexist with some hematological conditions or malignanices. Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Saddiq Ulabidin (25 hours later)

My doctor repeated the test today during the appointment and my NRBC was 0. My WBC count was the same. She was not concerned about it. I am wondering if it is worth seeking a second opinion. Additionally, I had a recent MRI(3 months ago) that was clear is it possible there is anything different (tumor,lesion) causing constant visual manifestations, headaches, and even night sweats and hot flashes. This is what constantly plagues me.

Thanks for the help

Answered by Dr. Saddiq Ulabidin (4 hours later)

Brief Answer:
Proceed with other blood work up

Detailed Answer:
Hi! It's good to know that NRBC count has come normal but if WBC count is still low, or on decreasing trend it may need to be tracked down with other blood work up like we had discussed specially in the context of the symptoms you had discussed.

Even though MRI is normal but can you kindly share what body parts MRI had you done. Because with visual manifestation and headaches MRI brain with MRA and MRV might be needed and for other screening purpose generally MRI chest, abdomen and pelvis is done to local any signs of visceral involvement, lymphedenopathy and splenic or liver enlargement.

Other blood work up which we had discussed earlier can be proceeded with and repeat CBC with peripheral films every three monthly might be needed. An oncologist and rheumatologist opinion will not be a bad idea. Wishing you a speedy recovery. Regards

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Vaishalee Punj