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What do these blood reports indicate?

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Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2877 Questions

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Posted on Mon, 2 Nov 2015 in Medicines and Side Effects
Question: I have had two different CBC with differential done (at different places) this last week. Both indicate WBC (specifically lymphocytes) below or nearly below normal. Second test (done by my doctor) also shows RBC nearly below normal. I have not felt well for three months. Doctor says latest results are normal. Yes, they are normal but just barely and I am concerned that my immune system is in weakened state and that something is causing the low numbers. I have not felt well that last three months. Are these results reason for concern?

10/6/2015
WHITE BLOOD CELL COUNT 3.7 L 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.01 4.20-5.80 Million/uL
HEMOGLOBIN 15.3 13.2-17.1 g/dL
HEMATOCRIT 46.7 38.5-50.0 %
MCV 93.3 80.0-100.0 fL
MCH 30.5 27.0-33.0 pg
MCHC 32.7 32.0-36.0 g/dL
RDW 13.9 11.0-15.0 %
PLATELET COUNT 213 140-400 Thousand/uL
MPV 7.5 7.5-11.5 fL
ABSOLUTE NEUTROPHILS 2157 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1180 850-3900 cells/uL
ABSOLUTE MONOCYTES 285 200-950 cells/uL
ABSOLUTE EOSINOPHILS 56 15-500 cells/uL
ABSOLUTE BASOPHILS 22 0-200 cells/uL
NEUTROPHILS 58.3 %
LYMPHOCYTES 31.9 %
MONOCYTES 7.7 %
EOSINOPHILS 1.5 %
BASOPHILS 0.6 %


10/9/2015
WBC OP 4.3-10.8 K/uL 4.8
RBC OP 4.60-6.20 M/uL 4.78
HEMOGLOBIN OP 14.0-18.0 gm/dL 14.9
HEMATOCRIT OP 40.0-54.0 % 44.2
MCV OP 80-100 fl 93
MCH OP 27.0-33.0 pg 31.2
MCHC OP 33.0-36.0 gm/dL 33.7
RDW OP 11.5-14.5 % 13.2
PLATELET COUNT OP 150-400 K/uL 185
MPV OP 6.5-12.0 8.8
PMN % OP 69.9
LYMPHOCYTE % OP 22.0
MONOCYTE % OP 7.3
EOSINOPHIL % OP 0.6
BASOPHIL % OP 0.2
PMN ABSOLUTE OP 1.80-7.80 K/uL 3.36
LYMPHOCYTE ABSOLUTE OP 1.00-4.00 K/uL 1.06
MONOCYTE ABSOLUTE OP 0.00-1.00 K/uL 0.35
EOSINOPHIL ABSOLUTE OP 0.00-0.45 K/uL 0.03
BASOPHIL ABSOLUTE OP 0.00-0.20 K/uL 0.01
doctor
Answered by Dr. Saumya Mittal 1 hour later
Brief Answer:
Suggest a vitamin d test

Detailed Answer:
Hi
I am Dr Mittal.
I have read your message.
I think I can help you.
The CBC is indeed looking normal.
However as you said some of the indices are just within norms.
Considering the fatigue and tired state I would suggest another test- vitamin D.
Test this also.
If this is low you will need to start replacement therapy.
Meanwhile you can start vitamin B complex medicines.
I have tried to make it as simple as possible. I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal 50 minutes later
Last vitamin test was 8/31/15, value = 37. Vitamin D level has been below normal in past so I have been taking 5000mg/day supplement for last two years.

Does low lymphocyte count suggest weakened immune system?
Last vitamin D test was 8/31/15 ...
doctor
Answered by Dr. Saumya Mittal 5 hours later
Brief Answer:
Explained

Detailed Answer:
Hi.
The low lymphocytes count may be a marker of ongoing infection. DLC is actually a percentage system. This means that the actual lymphocytes count may be normal ( as in your case) but because there is an infection the ratio is less because the other infection fighting mechanism are more or raised.
I hope that the information in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal 15 hours later
Thank you. In my case the latest test shows lymphocyte count (1.06) and percentage (22%) both near low end of range, with neutrophil count normal and percentage (69.9%) near high end of range. I do see how one count going up or down can affect the percentages. My lymphocyte count is low causing high neutrophil percentage. So just to confirm, the low lymphocyte count DOES suggest ongoing infection. Is that correct?
doctor
Answered by Dr. Saumya Mittal 20 minutes later
Brief Answer:
It's reverese

Detailed Answer:
It's actually the high neutrophil count that suggests an infection.
I would suggest that you get a blood culture tested.
if it's an ongoing infection , treatment with antibiotics would be better.
I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Saumya Mittal 1 hour later
Do I just ask for "blood culture"? Is that the name of the test? I have had a peripheral blood morphology and a serum electrophoresis. Do those tell if there is blood infection?
doctor
Answered by Dr. Saumya Mittal 0 minute later
Brief Answer:
It's a different test

Detailed Answer:
Hi
Blood culture is a different test.
the tests that you mentioned don't suggest infection.
that's not their role.
Blood culture Is enough.
Best of luck.
Dr Mittal.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Saumya Mittal 20 minutes later
If I had a blood infection for the last three months, what would be the symptoms? I don't have raised temperature or digestive problems or low blood pressure. I do have sore throat, sinus congestion, muscle aches, fatigue, mild headaches, brain fog.
doctor
Answered by Dr. Saumya Mittal 11 hours later
Brief Answer:
This sounds like sinusitis

Detailed Answer:
Now that you have mentioned the symptoms, it all fits in.
This is probably sinusitis.
A chronic infection that will not cause much fever.
But all other symptoms are typically that.
I will suggest avoiding blood culture.
Start with a steam inhalation 4 times a day.
start with a warm saline gargles 4 times a day.
Start a multivitamin of any brand as available locally, if not already on it.
Nasal drops 4 times a day.
If you can, lom vilom and kapal XXXXXXX are good yoga exercises for the sinusitis.
And needs some antibiotics for a long term period.
This has to be as per the local sensitivity.
Therefore you will need to meet an ENT specialist in your area.
And get an x ray PNS waters view to confirm the diagnosis.
I hope that this helps.
Best of luck.
Dr Mittal
Above answer was peer-reviewed by : Dr. Prasad
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