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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does this blood report indicate?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 106 Questions

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Posted on Mon, 6 Mar 2017 in Digestion and Bowels
Question: I was sick with a stomach virus 14 days ago. It lasted about 5-6 days with throwing up , diarrhea and fever. Just had a blood test 2 days ago and my WBC was 16.5 and my RBC was 4.11. I've been dealing with Trigeminal Neuralgia for 6-8 weeks now and have been taking Tylenol and IB Prophen up to 6-8 a day. My ALT and AST were slightly elevated too. So worried about leukemia!! Please respond! XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 4 hours later
Brief Answer:
Information

Detailed Answer:
Hello,

An elevated white blood cell count is more often due to recent or current infection or inflammation than it is to leukemia. However, it should be watched to make sure that it is not continuing to rise. Also, a peripheral blood smear (another blood test) can show which cell lines are elevated and how much.

The elevated liver enzymes may be due to the Tylenol and also the stress of illness. Liver enzymes can go up in response to gastroenteritis too (stomach virus).

So I would not jump to the conclusion that you have leukemia, especially when you have more obvious reasons for these labs to be abnormal. But do follow up in a few weeks, and have a repeat CBC and a peripheral blood smear done.

I hope the helps to reassure you.

Please let me know if I can provide additional information.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 10 hours later
Thank you so very much!! I am to get a repeat CBC today. I will let you know.

I've had a painful 6-8 weeks with Trigeminal Neuralgia and this is the reason for starting the Tegretol. Since having the TN the electrical pain have settled with the Tegretol but the jaw pain is constant. Every time I talk or open my mouth at all it is so painful. If I had an X-ray done would it show any infection?

Could TN cause an increase in white blood count? Or TMJ of the jaw?
Thank you once again for your time. Blessings - XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 18 minutes later
Brief Answer:
Information

Detailed Answer:
Hello XXXXXXX

An X-ray is not always the best way to see if there is an infection. It may show up, but not always. An MRI would do a better job of showing that if an X-ray doesn't provide enough information.

What type of doctor are you seeing for the trigeminal neuralgia? And was your jaw pain diagnosed as being part of the TN? Because as you are questioning, it may be separate unless the symptoms came on together.

Physical stress can cause an elevation in white blood cells. But I think it would be a good idea to look for a source of infection.

And if you have the CBC today, ask your doctor (if it wasn't ordered already) to order a peripheral smear. This is just an additional exam the lab can do using the CBC blood, where they actually look at the blood (not just run it through an automated counter) and see what cell types are high.

By the way, Tegretol can temporarily cause an elevation in liver enzymes.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 28 minutes later
Thank you for your response. I will let you know any results today.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 11 minutes later
Brief Answer:
Thank you!

Detailed Answer:
Thank you - I appreciate the follow up.

Good luck on your recheck today.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 3 hours later
I noticed on my last test 3 days ago that the RBC Morphology was normal. And it said the blood smear was present? Don't know what either of these mean. No results from today's tests yet. Praying they are down.

I've had the TN for a year or more and the jaw pain for maybe 6 weeks. My dentist is sending me to an oral surgeon for the X-ray. My dentist does not do the 3 dimensional X-ray he feels is needed to check the TMJ. (Jaw). The jaw pain is deep -where I can feel the hinge- and when I get it the pain will last for 10 minutes to 30 or more minutes. It is not the electrical pain like I experience with TN. Moving my jaw is painful.

Thank you again. XXXXXXX


My tests results are in. I did a fasting but realized I did not need to. Went in at noon today.
Hepatic Function Details
alkaline Phosphate was 156. (34 to 144)
Gamma GT
Was 452
(9-51)
AST was 174 (13-40)
ALT Was 267 (7-52)

WBC 15.2
RBC. 4.10
Neutrophils 27
Lymphocytes 59
Lymphocytes Absolute 8.99. (0.90)
Monocytes Absolute. .61. .00-.40
RBC Morphology Normal
Manual Diff Review. "Reviewed"

I'm so upset!! I don't know what any of these mean. Please help. XXXXXXX
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 2 hours later
Brief Answer:
Information

Detailed Answer:
It's possible that a peripheral smear was done on the original CBC if they were able to tell the morphology of the red blood cells. I am interested in the differential of the white blood cells (how many neutrophils, lymphocytes, etc). When you get the results, you can share them with me if you wish, by uploading them to this site. There is a "button" on the side of the screen that reads "Upload Reports".

It does sound like the pain is related to your jaw joint rather than the neuralgia. The oral surgeon should be able to sort the cause of the jaw pain out.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 24 minutes later
What about the gamma gt. It is high and the AST and ALT both went up. Can Tegretol be causing any of this?
I'm actually taking carbamazepine 200 mg. Right now still taking 1/2 tablet 2x a day.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 17 minutes later
Brief Answer:
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Detailed Answer:
Yes, these are all liver enzymes, and they all can be affected by carbamazepine. How high were they? Mild elevations aren't usually concerning.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 32 minutes later
I can't figure out how to send them.
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Answered by Dr. Bonnie Berger-Durnbaugh 19 minutes later
Brief Answer:
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Detailed Answer:
I am so sorry, I did not see that you had written your labs in above. Sometimes the posts come out of order.

Your GGT is very high. Usually we see this if people drink alcohol, but if you don't drink any alcohol, then I suspect it is from your medications. And I recommend pursuing this with your doctor.

Regarding your white blood cell counts, the total wbc count is not any higher than it was a few days ago so that is good, but you may not see a decrease, if the counts are high from infection, for a couple of weeks. I recommend following up with your doctor to pursue any sources of infection (including your jaw as you haven't had that problem before) as you may still have an infection going on.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 11 minutes later
Do you have an email where I can take pics of my tests and send them
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 18 minutes later
Brief Answer:
Information

Detailed Answer:
Hi -

The CBC from a few days ago (wbc 16.7) are uploaded here and I can see it. Perhaps you can do that with the labs from today?

If you are unable to do the same with the labs from today, you can email them to customer support/customer care and they will get them to me.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 26 minutes later
Today's test.
Protein total serum. 6.8 g/dl. 5.6-7.7
Albumin. 4.0g/do. 3.5-4.9 g/dl
Report reflects use of bromocresol green methodology
Bilirubin total. 0.7mg/dl. 2.2-11mg/dl
Bilirubin Direct. 0.2 mg/dl. 0.0-0.2
Alkaline Phosphatase. 156U/L. 34-144 U/L
Gamma GT 452 U/L. 9-51U/L
Indirect Bilirubin. 0.5. Mg/dl
AST(SGOT). 174 U/L. 13-40 U/L
ALT(SGPT). 267U/L 5-52 U/L
2-13-17

Drawn on 2-11-17
Comprehensive Metabolic Panel
Glucose serum. 96mg/gl. 65-100
Blood Urea Nitrogen. 21 mg/do. 8-23
Sodium. 138mmol/L. 135-145
Potassium. 4.4 mole/l. 3.4-5.3
Chloride. 102 mm ok/L. 98-107 mmmol/l
CO2 Venous 32.0 miles/l. 21-31 mm ol/l
Anion Gap 4 mmol/l. 5-15 mmol/l
Creatinine 0.8mg/dl. 0.8-13
BUN Creatinine Ratio 26 ratio. 10-20 ratio
Osmolality calculation serum 279 mosm/KgH2O
275-300mosm/kgh2o
Calcium 9.5 mg/do. 86-10.3 mg/dl
Protein total Serum. 6.6g/dl. 5.6-7.7
Albumin. 3.9g/dl. 3.5-4.9g/dl
Result reflects use of Bromcresol methodology
Bilirubin Total. 0.5. Mg/dl. 0.2-11 mg/dl
Alkaline phosphatase. 105u/l. 34-144 u/l
AST (SGOT) 72 u/l. 13-40 u/l
ALT(SGPT) 87u/l. 7-52u/l
AGRatio 1.4 Ratio 1.0-2.0 Ratio
Globulin. 2.7gm/dl. Gm/dl
GFR. >60ml/min/1.73sqm. Ml/min 1.73sqm
Calcium, corrected (Adj/CalC) Total. 9.6mg/dl



doctor
Answered by Dr. Bonnie Berger-Durnbaugh 18 minutes later
Brief Answer:
Information

Detailed Answer:
Thanks for providing this detail.

What stands out are the elevated GGT and Alkaline phosphatase (and to a lesser extent, the other liver enzymes).

When both GGT and Alk Phos are elevated together, the most common causes are biliary problems such as gall stones, alcoholic liver disease, or medications including the carbamezapine.

Is there any way to switch medications now that the trigeminal neuralgia is less?
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 1 hour later
This wouldn't be liver cancer would it? I don't have any of the symptoms of diarrhea, loss of weight,pain etc. my dr just called and took me off of Tegretol. Praying this turns everything around.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 3 hours later
Brief Answer:
Information

Detailed Answer:
There are well documented case studies of carbamazepine causing abnormalities like this. So before assuming liver cancer, wait and see if the problem with the liver function tests aren't from the medicine.

Unfortunately, to see liver enzymes return to normal, it takes around 4-6 weeks for the hepatocytes (liver cells) to regenerate. So you may not be able to have normal test results for another month and a half. That is, if the elevated liver enzymes are due to inflammation of the hepatocytes. Liver enzymes can also rise because of something called "enzyme induction", where a medicine causes cells to just step up their production of an enzyme.

Either way, I think it is wise that your doctor took you off the Tegretol (carbamazepine).

I also found an article that talks about the possibility of atypical lymphocytosis (elevation in lymphocytes) that can happen with carbamazepine, although this is a rarer possible reaction to the medication.

I will say a prayer too that this turns everything around. I think it is likely that it will.






Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 7 hours later
Thank you. I'm glad they stopped the meds last night. I did not take my evening dose. I started the Tegretol a week ago and that was Tuesday. By Saturday the ast and alt were at 72 and 87 I believe. Not positive of the numbers. Then just 2.5 days later they had more than doubled. Do you think they could be down even a little by tomorrow after stopping the medicine? I hope there is some indication that this is the problem.
He asked if my eyes were yellow at all and they are not, thank goodness. The one dr said I may be headed into liver failure then another dr called back and said no I'm not. He said numbers go into the thousands when you start heading that way. I'm shaken by all this. Can my liver heal? Thank you once again.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 10 hours later
Brief Answer:
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Detailed Answer:
Hello -

The liver has an amazing ability to heal. And as the doctor who mentioned about liver enzymes going into the thousands, yours were too high, but not at the point of liver failure.

It's possible your enzymes will be a bit lower after a couple of days, but really, it will take a few weeks for the liver cells to turn over new ones. Also, there are some studies that suggest the elevated liver enzymes from carbamazepine are not from liver cell damage but from "enzyme induction" without damage. This means the rate of enzyme production itself is turned up. Again, it will take awhile for things to reset.

But now that you are off of the Tegretol, your body should start to return to normal.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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