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What Is The Treatment For Dropping Lymphocytes Level?
Question: Hello, I am a 42 yr old female with that had a cholystectomy Sept of 2012 and two months after the surgery my spleen liver and left tonsil became enlarged. Prior to this I was a professional athlete in excellent health and nurse. I don't drink and have never smoked. The cancer center I was going to thought I had some type of lymphoma. I had a pet scan ,bone marrow biopsy one yr ago and were neg. All infectious disease were also ruled out. At the time of enlarged spleenliver tonsil.I had hypercalcemia and still have it. DR stated it could be 1 Alpha Hyd absorbtion heptosplenamegalysillectomy that showed abnormal hyperplasia tissue last year. I was put on high dose steroids for 4 months and then developed 4 sm bowel masses that showed up on a pill capsule study. When I had a exp lap nothing was seen and a liver biopsy was also done because I had 2 unknown lesions that were neg. post surgery two months my rbc and lymphocytes are dropping every week and neutrophils are elevated with a calcium of 11.1 cortisol level elevated at 29 tsh elevated and free t4 low so I was started on armour thyroid med this week . My energy levels have also dropped significantly. I have a creatine of 1.33 and two kidney stones due to high calcium. 24 hr urine showed calcium very high in the 500s. My concern is my lymphocytes dropping to 12 and if I need to get a bone marrow biopsy. I also have a nodule in the right lung that showed up in Aug and wondering if I should also get a pet scan. One recent Dr stated my spleen is enlarged again and I am scheduled to see a oncologist next week prolactin level ,fsh lh was also elevated.
Brief Answer:
you need to get investigated again
Detailed Answer:
yes, since your counts are dropping and a nodule is seen on the right lung, you definitely need to get investigated again. it is not necessary that you have cancer, but seem to have so many disturbances in harmone and electrolyte levels that you need to see an endocrinologist also.
From oncology point of view, harmone abnormalities without obvious cause can occur in paraneoplastic syndromes. This syndrome is due to chemicals secreted by cancer cells. To say paraneoplastic, focus of cancer needs to be located. This can be done by PET CT and bone marrow biopsy. If both are normal, it is very unlikely that these abnormalities are due to cancer. You can safely forget about cancer and seek consultation of other doctors especially endocrionologist and immunologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. When I was tested one yr ago in Houston. They thought it could be a low grade lymphoma. I'm seeing a DR next week here in Florida but the oncologist in Houston thinks I need a repeat pet,bone marrow and pill capsule study,,she feels like it is odd that there were clear pictures on the pill capsule of ist study one mass and 2 months later I had another pill capsule study and there were 4 masses. A hematologist that I worked with in Bone marrow transplant for many years said it could be a low grade lymphoma back then and I saw a endocrine Dr here in Florida last week that said my spleen and liver feel enlarged again and could be a type of leukemia. So you would get the tests done to rule out but not worry so much about leukemia or lymphoma with these issues and lymphocytes low and rbc,hgb and hct also just borderline low at 11 hbg. Im a nurse so of course Im worried. Would the cortisol of 29 still be screwed up from being on steroids 6 months ago. Im very hestitant to start taking thyroid meds even though my tsh was elevated and free t4 low. Every DR Iv seen is pretty confused about my case and I feel much worse now,like toxic feeling and very weak. Thank you for your help
what does it mean if gamma,albumin and eta is detected in the urine light chain test,Alpha 1 and Alpha 2 was not detected
Brief Answer:
need to continue thyroid medication
Detailed Answer:
From all that you have written, one very important thing that I recommend is you need to stop worrying and start taking thyroid medication. Thyroid hormone replacement is mandatory when the levels are low.
Your urine results say that low weight molecules are leaking through the kidney and passing into the urine. This can happen when they are in excess or the kidney is unable to filter and retain them. Both needs to be looked into.
You don't have each one in isolation but all your symptoms fit into single diagnosis which I am not able to answer since I have not examined you. Clinical examination is very important to arrive at diagnosis. Anyways all I can say is you need to be investigated further. Please don't worry over each lab report and please don't stop taking medication.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Hi Dr XXXXXXX XXXXXXX Konatam
so I took your advice and started on Armour Thyroid instead of synthroid. It is making me have more tremors than I was already but the endocrine DR reassured me that I would get used to it. I saw the new oncologist and he ran a series of blood tests Jak 2, perphial blood smear showed macrocytosis and anisocytosis,Leucocytes were normal but lymphocytes were 4,flow cytometry,hepatits panel,HIV,coombs,M spike were all negative. My total protein and albumin were high and my creatinine is high at 1.83 and E-GFR was low, IgG,IgA and IgM were on the high normal. He sent me to have a repeat CT of the Chest and it showed a focal subpleural density in the right lung but didn't say if it had grown with the millimeters it just said it was stable and I have a kidney stone in the right mid portion of the kidney from the Nov scan when it was found so the oncologist will have to follow up on that. Is that bad in that area of the lung? My calcium has been getting higher at 11.5 and the Dr still doesn't know what is wrong. I am having more SOB and chest tightness and more fatigued and gen weakness. I just have this toxic feeling and feel maybe I should go back to Houston and see my oncologist there. Do you have any ideas of what tests I should get done next. I did talk to my oncologists in Houston by email and she thinks I should repeat a pill capsule and get a pet. I had conflicting reports here in the last week also regarding my kidney stone. The ultrasound said my spleen was only slightly enlarged and my liver was normal and I had a 7mm stone on the right and a 2mm on the left,then 2 days later I had a x-ray of the abdomen to see the position of the 7 mm stone read by a different radiologist and it said I had 2 stones on the right 4 mm each and nothing on the left and I had the CT Scan yesterday and it didn't have any measurements of the lung nodule or the right kidney stone. I talked to the urologist by phone and he said that's not possible for a 7mm stone to break up into two 4mm and the CT Scan was suppose to be definitve and it didn't have any measuresments it just said kidney stone on the right mid portion. The reason for wanting to know if its a 7mm its not passable and they would possibly do lithotripsy. I worked in Bone Marrow transplant in Houston for 15 yrs and I have never seen such malpractice here in Florida. The oncologist here seems to be ordering the right tests but I think he should have just ordered the pet and be done with it. Sorry so long but I'm really upset and confused and am feeling worse and don't know whats wrong with me and what to do next. Please Help!!
I received a new addendum from a different radiologist and now it says I have a stable 4mm nodule in the inferior right upper lobe from previous Ct and a new nodule 2 mm from Nov in the right lung base. calcium today is 11.7, rbc 3.95,lymphocytes 12 and creatinine 1.33,WBC 5,HGB 11.9 and hct 36
Brief Answer:
you need further investigations
Detailed Answer:
you did not get two important investigations done, that is, PET CT whole body and bone marrow biopsy. Also you did not tell me the result of the battery of tests you underwent. I presume they all are normal.
Remember one important thing. Any lesion on CT scan less than a centimetre need not be given credence especially when there is no clinical correlation. Your lung lesions will not cause SOB as they are too tiny.
If the shortness of breath is bothersome, you need 2 D Echo. if echo is normal, Pulmonary function tests will throw light on the type of abnormality.
One thing is sure. If PET and bone marrow are normal, forget about cancer and you need not see oncologist. you need to see immunologist as i said before. You need to get investigated for other immunological and connective tissue and endocrine disorders
Dont worry. Stress can also precipitate certain diseases.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hello
I talked to a rheumatologist and endocrine Dr again today and they think this is not a Rheumatology disease and the endocrine Dr said that the hypercalcemia is either a humoral malignancy versus infiltrative/inflammatory disease and I should be getting a PET. The Rheumatologist was concerned about the macrocytosis and the urine light chains being positive and to see a different oncologist. The oncologist's nurse practioner that I saw yesterday wants to wait and do another CT Scan in 4-6 months and cont doing weekly labs although my calcium level is now 12.1 and creatinine this morning was 1.5 lymphocytes 12,rbc 3.5 and hgb 11.1. I feel terrible. More lethargic and toxic feeling. The new nodule is only 3mm non calcified at the right lung base from Nov and the old nodule 4-5mm is in the upper portion of the right lung. What do you suggest to see a different oncologist?This doesn't seem right to me to just wait if I'm feeling this bad especially if my calcium and creatine keep going up. Thank you for your help
one other question. on my flow cytology. My cd 45 anchor leukocytes is 98% positive is this bad? Also Macrocytosis anemia
Brief Answer:
you have still not got the tests done
Detailed Answer:
Dear Madam,
I have been writing repeatedly that you will need bone marrow. Multiple myeloma and other infiltrative disorders need to be ruled out which can be done by bone marrow examination. good that you do not have rheumatological disorders.
You need to see good hemoncologist to rule out myeloma.
Regarding flow report, we dont make conclusions based on single finding. To make a conclusion from flow report we need to findings which can be correlated to come to a conclusion. Isolated findings have no importance.
Regarding advise from nurse practisioner, i dont think you can wait. You need get worked up properly, all your biochemical abnormalities need to be corrected, for which accurate diagnosis is essential.
Your condition is not psychological as you have clear cut abnormalities in lab reports. So please consult good doctor and get investigated for infiltative disorders.
take care
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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