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    What do the following blood test report indicate?

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Posted on Mon, 14 Aug 2017 in Cancer
Question: Dear sir
my mother she is 68 years now.In 2010 she was diagonsed with NHL B large grade grafe in stage 4 .she had undergone 8 cycles of RCHOP CHEMOTHARPY.Afer 6 cycles per ct was done and its clear and after that 2 more cycle also given for precautnary measure.After that she is under observation, but due to cancer her L5 AND L4 IS COLLAPSED for that she is not able to sit and walk.then after that she undergo the decomprasdion of nervers surgery from collapsed l4 &l5 in 20!2.after that she is able to sit for sometime and able to walk some steps with support but still companing of and on in thighs specially in night.but no pain in back or spine area only compaing in thighs outer side w0e did lasr PET CT in 2016f eb (report attached) there is nothing.all well.her regular routine blood test have been on 26 july2017 (report attached) but lymphoctes are on higher side we are little worried on that because its never seen in past.kindly advice
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Can't see the reports

Detailed Answer:
Hi
Thanks for your query.

It is good to know that your mom is doing well. However, I don't see any attachments. Please upload them so that I can answer your query.

If you have problems uploading, then send them to YYYY@YYYY with subject attn Dr Indranil Ghosh.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh 24 minutes later
Dear sir i am sending current blood test which is worrying us
doctor
Answered by Dr. Indranil Ghosh 9 minutes later
Brief Answer:
This is suggestive of increased lymphocytes

Detailed Answer:
This report is concerning. The total leucocyte count is 14000 with 70% lymphocytes which makes the total lymphocytes close to 10000. Their appearance is also not normal, with presence of smudge cells. This picture is suggestive of chronic lymphocytic leukemia. If the patient had small cell lymphoma earlier, then this could well be a recurrence. Small cell lymphoma and chronic lymphocytic leukemia are basically same.

But then you mentioned that previously she had large cell lymphoma. Then the present manifestation can't be explained by a recurrence. It may be the unlikely event of a new disease.

I recommend getting the current blood picture reviewed by an expert hematopathologist, in conjunction with the previous biopsy. We can also do flow cytometry analysis on blood to get the exact current diagnosis.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 38 minutes later
i am sending you the discharge summary of the mother where its already mantioned large diffused b grade NHL
doctor
Answered by Dr. Indranil Ghosh 7 hours later
Brief Answer:
I could not find the attached discharge summary

Detailed Answer:
However, if it's clearly diffuse large b cell lymphoma, then it can't explain the current blood picture. The previous biopsy and current blood picture should be reviewed by an expert and flow cytometry done, as I mentioned earlier.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 58 minutes later
Dear sir i checked all old.papers its written NON HODGKIN DIFFUSE B CELL TYPE ATTACHING DOCUMENTS
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
yes it is large B cell

Detailed Answer:
You should definitely review the old biopsy, if the slides/blocks are available. And the flow cytometry on current blood is a must. That will give the clear diagnosis. Even if it is confirmed as chronic lymphocytic leukemia, no immediate treatment may be required if she is otherwise alright.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 43 minutes later
why no treatment is required if it is confirmed?
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Because it does not improve survival

Detailed Answer:
Chronic lymphocytic leukemia (CLL) is an indolent disease, very unlike diffuse large B cell lymphoma, which is aggressive. Hence, unless it is causing any symptoms like fever, weight loss, low hemoglobin, low platelets, etc, there is no benefit in immediate treatment. Rather we wait till it causes any problems. Years may pass without treatment.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 11 minutes later
She is having itching problem sometimes in the evening hours. And she is also having constipation off and on
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
These are likely not related

Detailed Answer:
Most likely these are unrelated issues and can benefit by topical skin preparations and laxatives respectively.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 3 hours later
Thanks a lot for your kind information .i wil be in touch with you and kindly advice we will wait to repeat the test again. i cjecked her prwviious paers too i found some test report of 2013 and 2016 witg some aimmilar data. her Tlc is always on higher side and sometimea qitg lymphocities too kindly see and advice
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Yes probably it is long standing

Detailed Answer:
Even then the flow cytometry should be done to confirm the diagnosis. And then repeat blood counts every 3 months to see the trend.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Indranil Ghosh

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