Unexplained elevated WBC and other strange blood test results - please help!
38 year old female. Elevated white count (12,000 to 17,500) off and on (mostly on) since 2007 without an acute infection. Current blood tests results (sample drawn 4/3) revealed elevated WBC, elevated neutrphils and elevated folate. Still await a number of other results. Past labs have revealed elevated neutrophils, monocytes, lymphocytes and basos. The differential from 3/21/13 just came back with "large" platelets and a liver panel from Feb 2012 revealed elevated ALK which was determined to becoming from the bone. Other unexplained results include low iron without being anemic. My symptoms are unexplained premature ovarian failure at 35 y/o, chronic fatigue, chronic diahrrea, blinding migraines, severe abdominal bloating, nausea, abdominal pain (upper right quad and lower left quad), unexplained extreme weight gain (85 lbs), pain to light touch, bone pain, and joint pain. I have had every test you can imagine, ultrasounds, cat scan, MRI's, upper endoscopy, colonoscopy, hepatobiliary scan, breath tests, defoscan, and more. Several "cysts" have been found in various parts of my body and I do have a past history (17yrs) of ovarian cysts (CA125 negative, BRCA 1 & 2 negative). The Dr's continue to state that the cysts are of no clinical significance. The one I am mostly concerned about is the one within my spleen which appears to be growing. CT report states - hypoenhancing lobulated lesion at the anterior/inferior margin. It went from 23MM to 3.0 CM since last year. Additionally, the CT I had last week revealed that I now have a "fatty" liver, but the one I had in December of 2012 my liver and gallbladder was completely unremarkable. I am at a loss and I am sick and tired of being sick and tired.
Cysts in spleen are and can be a multi-organ cystic disease affecting liver, kidney, ovary and spleen. It can be a congenital disease, a malformation of the lymphatic system called lymphangioma, or it can be due to cancer even. Since the cyst is growing in size, and you have elevated WBC counts, large platelets etc, a bone marrow biopsy may help. Also, chronic fatigue syndrome, IBS, Crohn’s etc should be ruled out. Peristent diarrhea could be due to bowel inflammation, and this can cause low iron too. You must also get a complete hormone profile, including tests for insulin resistance as you have ovarian cysts too. Please discuss this with your doctor. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
Thank you for your response Dr. Mathur. I have had a series of health events since my last post. I actually ended up with vaginal bleeding after 21 months of no period and a year after I was diagnosed as menopause. I was brought in right away and they were going to do a biopsy of my endometrial tissue but they were unable to because I could not withstand the pain of the clamp or entry through the cervix. They stop the procedure, sent me for another US, took more blood and scheduled me for surgery. In all honesty, I left there feeling like an elephant had been lifted. They were finally going in with a camera to determine what in fact is going on. Grateful for surgery? Who thinks like this unless they are in excrutiating pain? In any event, I received a call the last Thursday from the gyn Dr. advising me that based on her thorough review of my entire medical history, coupled with the most recent events and together with my new lab results, she doen't feel that she would be the appropiate surgeon for my case and she is sending me to the Chief of Gyn for a 3rd opinion and to take over my case. She stated that while she believes it may be scar tissue build up causing the pain, there is no way of knowng for certain until they are in and she wants me to have someone with the capacity to deal with any surprise findings, such as tumors, etc. I felt the blood drain from my body at that point. I thanked her for her honesty and started dealing with the scheduling with the new doctor, whom I cannot get in to see until June, so now I have to endure another 2 months of pain. Not happy about that at all. In the meantime, my new labs have been coming back slowly but surely and they sent my US to another department which does 3D Reconstruction of the images. Not sure what to make of that but I do note that they are unable to find/see my left ovary, which is the site of the lower left quad pain.
Since my last post here are the "abnormal" lab findings:
Smooth muscle AB Titer - Positive at 1:80 - all other AI tests were negative.
Elevated ALK Phos at 110 - HCV negative - isoenzyme results pending, but previously determined to be coming from my bones.
Elevated DHEAS at 247
Elevated Anion Gap at 21
Low CO2 at 20.7
"Normal" range lab findings:
GFR, Creatinine, BUN, Globulin, Almumin, Bilirubin, ALT, AST, Sodium, Calcium, Potassium, and Chloride. Also normal were the SHBG and Testosterone.
My Glucose was 83 and Mean Blood Glucose was 111 - Don't know if these are normal values.
Pending Results: 17 OHProgesterone.
When I asked my PCP about the posiitve result for the SMA AB finding she stated and I quote "The smooth muscle antibody is borderline at 1:80; the other antibodies and markers for autoimmune disorders are negative, including your sed rate. Your alk phos was 110 instead of 100-this isn't really a significant elevation; we can see if the lab will do the isoenzymes, but again, the elevation is negligble at best."
I do not feel well at all. It takes all that I have to get dressed and out the door most days. I have all of the symtoms stated in my previous post but I have also noticed that I have had a slower response or word memory recall during conversations lately. For example I was speaking about my son's trip to Florida and instead of saying Florida like I was thinking the word California came out of my mouth. This has happened on several occasions over the last few weeks in very different settings including my appointment with the GI doctor. I also occasionally feel weak and faint lately and all I want to do is sleep even after a full 8 hours.
I feel like the doctors are wasting time. I have an extensive family history of cancers and I fear the worst. Please let me know your thoughts on next steps or questions/directions I can pose at my next round of appointments.
Finally, thank you very much for last advice, it proved very helpful in getting them to do additional tests, which resulting in abnormal findings.
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