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Dr. Andrew Rynne

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What causes swollen lymph glands in the neck, tiredness and elevated IgG levels?

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Dr. Shailja Puri

Pathologist and Microbiologist

Practicing since :2006

Answered : 7233 Questions

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Posted on Wed, 15 Mar 2017 in Lymphoma
Question: I AM A MED TECH IN A CRITICAL ACCESS HOSPITAL. I HAVE BEEN EXPERIENCING SYMPTOMS OF LYMPHOMA AND OR MONO AND HAVE BEEN SEEING A HEMATOLOGIST, BUT HE CANNOT DETERMINE WHAT IS WRONG.
FLOW CYTOMETRY SHOWS AND ELEVATED T CELL LEVEL. MY DIFFERENTIAL ALWAYS SHOWS REMARKABLY HIGH AMOUNT OF METACYTES, MYELOCYTES AND MY RED CELL MORPHOLOGY LOOKS LIKE IRON DEFICIENCY ANEMIA - LOTS OF ANISO, HYPOCHROMIA, AND MICROCYTES.
MY GLAND IS SWOLLEN IN THE LEFT SIDE OF MY NECK, I AM ALWAYS EXTREMELY TIRED - EBV IGG AND IGM ARE HIGH BUT HE DOESN'T THINK IT IS AN ACTIVE CASE OF MONO.
HE BELIEVES THE HIGH T CELL IS DUE TO MY PROFESSION.
HE HAS DONE ALL KINDS OF TESTING FOR CANCER, THE FLOW CYTOMETRY WAS A LAST DITCH EFFORT TO EXPLAIN MY SYMPTOMS AND CRAPPY CBC. I FORGOT THAT I HAVE CONSTANT EYE TWTCHING BUT THAT MAY BE DUE TO WITHDRAWAL FROM XANAX. MY SON COMMITTED SUICIDE AND I HAVE BEEN DIAGNOSED WITH PTSD AND TRYING TO GET OFF ANTI-ANXIETY MEDICINE
doctor
Answered by Dr. Shailja Puri 3 hours later
Brief Answer:
No evidfence of lymphoma or active infectious mononuclesis

Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.

At the onset, I would like to say microcytosis, hypochromia and the anisocytes are indicative of iron deficiency and that treatment of iron deficiency anemia is very important. So, consult your hematologist for treatment of iron deficiency.

Swelling or enlargement of lymph node may be due to lymphoma. I would suggest you to get an aspiration cytology of the enlarged lymph node. That being said Elevated T cell lymphocytes on flowcytometry is not suggestive of lymphoma.

Presence of meta-myelocytes and myelocytes on peripheral blood smears is suggestive of shift to left- indicative of bone marrow stress. However, there is nothing much to worry.

In the nutshell, I don't think you could be suffering with lymphoma. Discuss about performing aspiration cytology on enlarged lymph node.

Infectious mononucleosis is not active currently since the Ig G levels are elevated.
Ig G levels increase when the active infection weans away.

If you have more queries, I will be glad to answer.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shailja Puri 1 hour later
MY IGM AS WELL AS IGG IS HIGH FOR EBV, IF YOU JUST WENT BY SYMPTOMS AND INCREASED ATYPICAL LYMPHS THEN I WOULD SAY MONO.
THE RBC MORPHOLOGY DOES LEAD TO THINK IRON DEFICIENCY ANEMIA
I PROBABLY HAVE AN ABSORPTION PROBLEM BECAUSE I EAT MEAT AND LEAFY GREENS - BUT WITH GASTRITIS I TAKE RANITIDINE.
MONO OR ANEMIA WOULD MAKE ME VERY TIRED AND THAT IS THE WORST OF THE SYMPTOMS. I PUSH MYSELF CONSTANTLY TO GET THINGS DONE.

ANY OTHER THOUGHTS?
doctor
Answered by Dr. Shailja Puri 7 minutes later
Brief Answer:
Tests for malabsorption and upper GI endoscopy suggested

Detailed Answer:
Hello and welcome again,
Infectious mononucleosis is usually characterized by high lymphocyte count and presence of reactive lymphocytes on peripheral blood smear.
Does your blood report show an absolute increase in lymphocytes?
Elevated T lymphocytes is not path-gnomonic of infectious mononucleosis.

If you are suspecting an absorption problem then you need get stool test for fat globules.
Fat globules appear in presence of malabsorption.

The cause of gastritis should be sought.
Long term intake of ranitidine will only provide symptomatic relief but not complete resolution to the problem.
I suggest you to consult a gastroenterologist for clinical assessment and upper gastrointestinal (GI) tract endoscopy.

Thanks and take care
Dr Shailja Puri





Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shailja Puri 52 minutes later
I HAVE AN INCREASE OF ATYPICAL (REACTIVE) LYMPHS

I WILL TALK TO MY DOCTOR ABOUT THE MALABSORPTION
AND TESTING FOR FAT GLOBULES.

THE GASTRITIS WAS FOUND ON AN UPPER GI ENDOSCOPY THAT IS WHY I TAKE THE RANTIDINE. THE CAUSE IS SOME MEDICATION I AM ON. I TAKE A LOT OF PAIN MEDICATION. HAD AN ADVERSE REACTION TO QUINOLONE ANTIBIOTIC - PERMANENT GLUTEUS MEDIAN TENDON DAMAGE ALONG WITH NERVE DAMAGE AND SHORT TERM MEMORY LOSS. ALSO CLASS II SPONYLOTHESIS OF L5 AND SI
- BOTH LEGS HAVE THE NERVES PINCHED OFF AND WALKING VERY FAR IS ALMOST IMPOSSIBLE.

DO YOU THINK THE EYE TWITCHING IS THE XANAX WITHDRAWAL?

THE L5 PROBLEM RUNS RAMPANT IN MY FAMILY. NOTHING TO DO WITH QUINOLONE ADVERSE REACTION. JUST ANOTHER REASON FOR THE PAIN MEDICATION.
doctor
Answered by Dr. Shailja Puri 17 hours later
Brief Answer:
An upper GI biopsy is required to rule out reflux.

Detailed Answer:
Hello and welcome again,
Long term use of pain killers leads to gastritis.
I suggest you to get stomach biopsy to rule out changes associated with reflux.
Eye twicthing can be due to anxiety associated with withdrawal of xanax.

Thanks and take care
Dr Shailja Puri
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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