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What Does The Following Test Report Indicate?
Question: 67 yr old male, Genetically healthy family with no histories, Overall healthy constitution, Other standard pathological reports Urine,Stool, Lipid, Sugar, B12, Kidney profile, Liver profile Chest XRay and Thyroid all normal range
Only anomaly in CBC – Increased Lymphocytes and low Neutrophils with high ESR
Data as follows along with past year
WBCs - Yr 2015=14200, Yr 2013=16,800, Yr 2011= 10,000
Lymphocytes - Yr 2015 = 72, Yr 2013 = 56, Yr 2011= 63
Neutrophils - Yr 2015=21, Yr 2013= 38, Yr 2011= 27
Platelet Morphology – ESR Yr 2015= 54, Yr 2013= 19, 2011= 28
2015 RBC Morphology - Mild anisocytosis, mild poikilocytosis
2015 WBC Morphology – Absolute lymphocytosis
25 Hydroxy Vitamin D serum - D3 – 12.7 NG/ML
BP range 100-140
Questions
According to GP reasons for the above could be due to age or bacterial infection or viral infection or colitis or worms or low folic acid or worst case scenario problem with blood or bone marrow….this is extremely vague. How to narrow down on what the problem really is, if there is any; what tests need to be done? Thank u in advance
Only anomaly in CBC – Increased Lymphocytes and low Neutrophils with high ESR
Data as follows along with past year
WBCs - Yr 2015=14200, Yr 2013=16,800, Yr 2011= 10,000
Lymphocytes - Yr 2015 = 72, Yr 2013 = 56, Yr 2011= 63
Neutrophils - Yr 2015=21, Yr 2013= 38, Yr 2011= 27
Platelet Morphology – ESR Yr 2015= 54, Yr 2013= 19, 2011= 28
2015 RBC Morphology - Mild anisocytosis, mild poikilocytosis
2015 WBC Morphology – Absolute lymphocytosis
25 Hydroxy Vitamin D serum - D3 – 12.7 NG/ML
BP range 100-140
Questions
According to GP reasons for the above could be due to age or bacterial infection or viral infection or colitis or worms or low folic acid or worst case scenario problem with blood or bone marrow….this is extremely vague. How to narrow down on what the problem really is, if there is any; what tests need to be done? Thank u in advance
Brief Answer:
CRP, peripheral smear and bone marrow biopsy study
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Increased ESR with lymphocytosis suggests chronic inflammation. Possibly long standing and slow disease.
2. As you are healthy, no infection can be thought of for now.
3. CRP or C-reactive protein levels estimation necessary to identify the amount of inflammation - whether it is ongoing.
4. As there is no diarrhea or abdominal pain- no colitis, or worms (no eosinophilia too). It is not bacterial infection - as no neutrophilia is seen.
5. You might be having joint pain or any pains anywhere - which is present since long time - This would help towards chronic inflammation.
6. Peripheral smear and bone marrow aspiration biopsy study along with C-reactive protein levels could help in possible identification of the cause. Do get this done. As there is no specific symptoms and all tests are normal, these can be tried towards identification of a possible cause.
Associated mild iron deficiency possible. Requires iron therapy along with Vit D therapy..
Hope it helps.
Any further queries, here to help again.
Dr. Prakash HM
CRP, peripheral smear and bone marrow biopsy study
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Increased ESR with lymphocytosis suggests chronic inflammation. Possibly long standing and slow disease.
2. As you are healthy, no infection can be thought of for now.
3. CRP or C-reactive protein levels estimation necessary to identify the amount of inflammation - whether it is ongoing.
4. As there is no diarrhea or abdominal pain- no colitis, or worms (no eosinophilia too). It is not bacterial infection - as no neutrophilia is seen.
5. You might be having joint pain or any pains anywhere - which is present since long time - This would help towards chronic inflammation.
6. Peripheral smear and bone marrow aspiration biopsy study along with C-reactive protein levels could help in possible identification of the cause. Do get this done. As there is no specific symptoms and all tests are normal, these can be tried towards identification of a possible cause.
Associated mild iron deficiency possible. Requires iron therapy along with Vit D therapy..
Hope it helps.
Any further queries, here to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He has NO joint pains. 2 years back he had mild chest congestion(bilateral perihilar congestion) that was resolved within 1 week. Since last 1-2 years he is complaining of slightly blurred vision and when he reduces intake of Adrak and Garlic he stops complaining. We checked with eye specialist it was NO problem at all and very good vision.
As for Peripheral Smear Report details are as follows
RBC : Hypochromasia Mild
WBC : Leukoctosis with Lymphatic Dominance
Platelets : Adequate on smear but few platelet aggregates seen
Questions
1) He has habit of eating peanuts everyday - is there any allergy issue?
2) As for Bone Marrow biopsy - what are the risks in the test. What exactly is done during this test? If at all any problem is found with bone marrow can this be resolved by only medicines? Is there a total cure?
As for Peripheral Smear Report details are as follows
RBC : Hypochromasia Mild
WBC : Leukoctosis with Lymphatic Dominance
Platelets : Adequate on smear but few platelet aggregates seen
Questions
1) He has habit of eating peanuts everyday - is there any allergy issue?
2) As for Bone Marrow biopsy - what are the risks in the test. What exactly is done during this test? If at all any problem is found with bone marrow can this be resolved by only medicines? Is there a total cure?
Brief Answer:
Not allergic issue.
Detailed Answer:
Hi,
Thanks for asking again.
No, 2 years back resolved complaint should not be a problem now. Peripheral smear shows the same lymphocytosis.
For your questions:
1. No allergy issue. There is no eosinophilia, so not allergy issue.
2. Bone marrow biopsy should not be any risk as platelet count is normal. During this test, a large bore needle is inserted into hip bone and bone marrow fluid is removed. This will evaluated to check for any cause.
I do not expect them to find anything. However, thats one test, which may show something. Treatment depends on them identifying something.
Again total cure, depends on what they identify - difficult to opine without bone marrow report.
C-reactive protein also needs to be tested. Do get it checked once.
Hope it helps.
Any further queries, here to help again.
Dr. Prakash HM
Not allergic issue.
Detailed Answer:
Hi,
Thanks for asking again.
No, 2 years back resolved complaint should not be a problem now. Peripheral smear shows the same lymphocytosis.
For your questions:
1. No allergy issue. There is no eosinophilia, so not allergy issue.
2. Bone marrow biopsy should not be any risk as platelet count is normal. During this test, a large bore needle is inserted into hip bone and bone marrow fluid is removed. This will evaluated to check for any cause.
I do not expect them to find anything. However, thats one test, which may show something. Treatment depends on them identifying something.
Again total cure, depends on what they identify - difficult to opine without bone marrow report.
C-reactive protein also needs to be tested. Do get it checked once.
Hope it helps.
Any further queries, here to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
ok thanks.
Dear Dr XXXXXXX Appreciate your answers but honestly going straight for some biopsy is not a path we may be able to pursue. What if the platelet report is in error and it adds problems instead of solving any & the biopsy itself causes issues.
As for C-Reactive surely that can be done but the fact that since last 2-3 years lymphocytes are erratic it does mean there is some inflammation somewhere.
We would rather use elimination rule to diagnose the issue. If possible please rethink the entire case again, outline all possible causes and eliminate and advise possibilities and solutions. We prefer nature cure options as far as possible.
Dear Dr XXXXXXX Appreciate your answers but honestly going straight for some biopsy is not a path we may be able to pursue. What if the platelet report is in error and it adds problems instead of solving any & the biopsy itself causes issues.
As for C-Reactive surely that can be done but the fact that since last 2-3 years lymphocytes are erratic it does mean there is some inflammation somewhere.
We would rather use elimination rule to diagnose the issue. If possible please rethink the entire case again, outline all possible causes and eliminate and advise possibilities and solutions. We prefer nature cure options as far as possible.
Brief Answer:
Improve nutrition and increase activity - Natural cure/control
Detailed Answer:
Hi,
Thanks for asking again.
1. ESR and increased lymphocytes - suggests chronic inflammation. I have not seen the platelet report and the first report, I thought was the ESR. Increased ESR suggest inflammation. Other causes could be low hemoglobin normally - low here means could be less than 10g%.
2. CRP would show an ongoing inflammation.
3. Identifying a cause without any symptoms is difficult. Single lymph node or a lump, anything if there, could be helpful for evaluation.
4. If we start searching, its like, getting endoscopy of whole body, ultrasound, MRI, etc. No specific test, without a location possible.
5. Better method would be to improve immunity through exercises and protein rich nutritional diet. Any symptoms, if it occurs in future, then re-evaluation possible.
Improving immunity with good diet along with a healthy life style would be the better option at present. No further serious tests or treatment advisable. If he were my patient, I would wait and watch, rather than start any kind of blind treatment or costly invasive complicating tests.
If you can name any disease, I will rule it out. Difficulty to name one, without any symptoms.
Hope it helps.
Any further queries, here to help again.
If you do not have any further queries, close the discussion and rate the answer.
Dr. Prakash HM
Improve nutrition and increase activity - Natural cure/control
Detailed Answer:
Hi,
Thanks for asking again.
1. ESR and increased lymphocytes - suggests chronic inflammation. I have not seen the platelet report and the first report, I thought was the ESR. Increased ESR suggest inflammation. Other causes could be low hemoglobin normally - low here means could be less than 10g%.
2. CRP would show an ongoing inflammation.
3. Identifying a cause without any symptoms is difficult. Single lymph node or a lump, anything if there, could be helpful for evaluation.
4. If we start searching, its like, getting endoscopy of whole body, ultrasound, MRI, etc. No specific test, without a location possible.
5. Better method would be to improve immunity through exercises and protein rich nutritional diet. Any symptoms, if it occurs in future, then re-evaluation possible.
Improving immunity with good diet along with a healthy life style would be the better option at present. No further serious tests or treatment advisable. If he were my patient, I would wait and watch, rather than start any kind of blind treatment or costly invasive complicating tests.
If you can name any disease, I will rule it out. Difficulty to name one, without any symptoms.
Hope it helps.
Any further queries, here to help again.
If you do not have any further queries, close the discussion and rate the answer.
Dr. Prakash HM
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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