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What Does My Lab Test Report Indicate?

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Posted on Mon, 23 Oct 2017
Question: I went to the ER mid August with a fever of 104 (untreated) and got admitted with fever and high liver enzymes. I had no rash indicative of a tick (or HIV for that matter) and no other symptoms, but the fever. My CBC WBC: 5.1 Neutrophils: 85% Lymphocytes 7%. Liver enzymes extremely high (ALT 310) with the fever. They tested for mono, typhoid, blood cultures for bacteria, and only found some abnormalities in urine. Doctors seemed stumped for two days. They treated me with general antibiotics and then antibiotics for tick after a ID consult. While in the hospital for 4 days my WBC fluctuated from 3.5 - 5.1 Infectious disease doctor said it was most likely a tick illness (even though no rash) or small chance urinary tract infection that went sepsis. My fever broke after 3 days (1 day upon starting doxycycline for tick) and within two days of ER visit my WBC was 4.5 Neutrophils 70% Lymphocytes back up to 20%. Doctors checked lymph nodes in neck and arm pits all normal. Blood work has ALL been normal since was pulled twice in September including my liver enzymes back to normal including ALT. I have not had sex in over a year so I'm not worried about ARS, but when I got discharged I started googling why my lymphocytes were low (wrong thing to do) I guess my question is if I were HIV positive and lymphocytes happened to be pulled down by HIV would they increase (triple) like that within two days? I didn't have high risk behaviors, don't use drugs, etc. was just going through a divorce a year ago and after googling thought what if he cheated. The Infectious Disease doctor said he was certain this was caused by a tick an didn't see a need to further investigate. The fever has not returned since I have left the hospital and have no other symptoms. Upon coming home from the hospital and further testing my lymphocytes continued to be above 20% in three blood draws between mid august and now and liver enzymes back to normal and WBC always above 4.0. Doctors said I'm healthy and don't need to see me until January. Below is my blood work when I got into the hospital and when I was discharged. Any thoughts?

Admitted to Hospital:
Admitted:
Wbc Count 5.60 K/uL
Rbc Count 5.03 M/uL
Hemoglobin 15.1 G/DL
Hematocrit 42.8 %
Mcv 85.1 FL
Mch 30.0 PG
Mchc 35.2 G/DL
Platelet Count 172 K/uL
Rdw 12.8 %
Mpv 9.2 FL
Neutrophils % 85.5 %
Lyphocyte % 7.0 %
Mono % 7.1 % 0.0 - 11.5 %
Eosinophils % 0.0 %
Basophils 0.4 %
Neutrophil Absolute 4.80 K/CU MM
Lymphocytes Absolute 0.40 K/CU MM
Monocyte Absolute 0.40 K/CU MM
Eosinophil Absolute 0.00 K/CU MM
Basophils Absolute 0.00 K/CU MM

Serum Albumin      4.4 GM/DL      
Total Protein      7.4 GM/DL      
Bilirubin,Total      1.2 MG/DL      
Alk Phosphatase      123 U/L      
Ast      310 U/L      13 - 39 U/L
Alt      261 U/L      7 - 52 U/L
Bilirubin,Direct      0.4 MG/DL

1 Month Later
WBC: 6.0
RBC. 4.40
HGB: 13
HCT: 39.5
MCV: 89.7
MCH: 29.5
MCHC: 32.9
RDW: 13.2%
PLT: 256
LY%: 20%
MO%: 5.7%
GR%: 74.3%

AST: 20
ALT: 15
ALK: 100
doctor
Answered by Dr. Noble Zachariah (1 hour later)
Brief Answer:
Discussion follows

Detailed Answer:
Hello,
Welcome and thanks for your query.
I understand your concern.
Glad to see that you are in good health and your blood tests are normal. The blood cell percentage varies from person to person and your present values in the clinical setting of no system is not a cause for concern.
I also feel that you had an infection which could have risen from a tick bite and you had liver inflammation as evident from the raised liver enzymes. The abnormal liver enzymes have returned to normal indicating the resolution of the inflammation.
There's nothing to suggest that you have HIV.
Googling does provide good information in many situations but unfortunately sometimes the information is confusing. So while raising your concerns with the doctor, trust your doctor's learned experience and the clinical picture more than Google.
Relax and enjoy the good health.
Do get back to me if you have further questions.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Noble Zachariah (8 hours later)
Thank you very much. In genera in HIV, would lymphocytes triple within 2-3 days? Mine have never gone back down since the few days in the hospital. I guess not having a true diagnosis (never having a tick rash or being tested for all tick borne illnesses) has me wondering. I would assume if it was HIV after a year of no sex these symptoms wouldn't be cured by an antibiotic and everything back to normal and feeling great. Thanks for your time.
doctor
Answered by Dr. Noble Zachariah (58 minutes later)
Brief Answer:
You are welcome

Detailed Answer:
Your normal lymphocyte percentage is about 20%.
During a bacterial infection, the percentage of Neutrophils increase ( in your case it was 85%).
This decreases the percentage of lymphocytes. When you were cured of the bacterial infection, neutrophil count and the lymphocyte count returned to their normal levels.
Therefore the change in lymphocyte percentage is not an indication of any HIV infection and as you very rightly concluded, the antibiotic you were given doesn't cure HIV.

So relax, enjoy good health and a great day.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah (8 hours later)
Thank you maybe 20% lymphocytes are my normal even on the lower end. Have a good weekend I need to stop thinking about what I had and know it's gone. If it were HIV symptoms wouldn't show for a day after a year and disappear with antibiotics. Appreciare your feedback
doctor
Answered by Dr. Noble Zachariah (23 hours later)
Brief Answer:
Welcome

Detailed Answer:
Yes, you can rest assured that HIV infection doesn't behave in this way and the antibiotics you received will not work with HIV.
You are normal. Relax and enjoy your life.
Do get back to me if you have further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah (2 days later)
I feel a lot better thank you and happy to not have any symptoms since leaving the hospital especially liver enzymes back to normal. They even tested for Hepatitis which was all negative. Would a patients blood work that was HIV positive look different then mine and/or take longer to recover from an infection like I had (possibly with the tick and 104 fever). thanks again you have given me peace about this! It was just in the back of my mind, but I do know I'm healthy :-) I know WBC can not have such rapid swings with HIV through research.
doctor
Answered by Dr. Noble Zachariah (3 hours later)
Brief Answer:
Most Welcome

Detailed Answer:
Hi,

Any other infection like HIV or Hepatitis B would not become normal in a short time.
Glad to note that you have overcome the anxiety.
It was nice interacting with you.

Wish you good health.

Do get back to me if you have any questions in the future.

Good day


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2320 Questions

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What Does My Lab Test Report Indicate?

Brief Answer: Discussion follows Detailed Answer: Hello, Welcome and thanks for your query. I understand your concern. Glad to see that you are in good health and your blood tests are normal. The blood cell percentage varies from person to person and your present values in the clinical setting of no system is not a cause for concern. I also feel that you had an infection which could have risen from a tick bite and you had liver inflammation as evident from the raised liver enzymes. The abnormal liver enzymes have returned to normal indicating the resolution of the inflammation. There's nothing to suggest that you have HIV. Googling does provide good information in many situations but unfortunately sometimes the information is confusing. So while raising your concerns with the doctor, trust your doctor's learned experience and the clinical picture more than Google. Relax and enjoy the good health. Do get back to me if you have further questions.