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Family Medicine (Expert Forum)
Elevated CBC...No answers
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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Elevated CBC...No answers
by xavi2871, Jul 20, 2003 12:00AM
I'm a 32 yr old overweight female for the past 4 yrs I have had chronic ear infections, asthma & bronchitis since my early teens. 2yrs ago my ankle began to swell & was sore. For 6 months I was told it was a sprain & finally the MD sent me to an orth. surgeon. They did surgery to remove what they thought was a sucessory (sp) bone the size of a golf ball. After analysis they found it to be a benign tumor. Approx. 1 yr later I began having immobilizing neck pain and after nerve testing I was told I had a herniated disk & severe carpal tunnel in both hands. I had corrective surgery on both but continue to have pain & numbness. In November of 2002 I woke up to pain in my right knee. It worsened over the following weeks & became visibly swollen, I had a hard time standing, sitting or sleeping. I went to my GP & after steroids, antibiotics, anti inflamatories & vicodin for 3 months he sent me to have an MRI & told me I had sever degeneration in the meniscus lining & knee cap & sent me to an Ortho. Surgeon. My left knee had begun to bother me & the surgeon said I had rhumatoid arthritis, draind the fluid from my knees to have analyzed & sent me to have a CBC to confirm arthritis. When I returned a week later he told me he could not treat me, my Gp was waiting to see me because he believed I had myeloma due to my CBC results which showed my:
WBC at 28.3, my RBC at 8.54, HGB 20.45, HCT 53.6, MCV 91.7, MCHC 36.6, RDW 17.5, MPV 12.2, Platelet 191, Neutrophils 75.9, Lymphocytes 17.8, Eosinophils 2.4 Basophils.5, left shift +1, RBC normal, CRP Ultra Sensitive 2.9
My GP retested me & they came back higher he treated me for pnemonia (pneumonia), an inner ear infection in both ears & changed me to percodan. 10 days later he redid my blood work said the difference was not noticable, started me on new antibiotics for a bacterial infection. I had trouble swallowing & went to ER for alergy (allergy). They did xrays gave me benadril & said I was fine. When I returned to my GP he told me to take the meds with benadril. 4 wks later he sent me to have CT of chest, abdomen, and pelvis. The results "Numerous bilateral 3cm & smaller paraeptal & centrilobular bullae with a 2.5 focal area of groundglass opacity & 2 1cm nodes in my lungs, several nodes near jugular & abdomen w/enlarged liver & left ovary enlarged with numerous cysts approx 5 cm no nodes or free fluid." My GP redid my CBC (cultures normal):WBC 18.3, RBC 7.94 but other numbers were not signifigantly changed. I was sent to an Oncologist for lymphoma & was told I didn't have all the symptoms & sent back to my GP. It's been 6 months since my first CBC & my WBC is down to 15.2, RBC 5.85 HGB 16.2, HCT 47.8, MPV 10.8, Neut. 72.4, lymph. 19.5. For 3 months I've been off work due to fatigue, fever, infection, & pain. I'm on clindamycin now for strep and ears & was told they cant find anything so I'll have to just wait until the cancer or whatever shows up. What do I do now? Any ideas of things they may have overlooked?
WBC at 28.3, my RBC at 8.54, HGB 20.45, HCT 53.6, MCV 91.7, MCHC 36.6, RDW 17.5, MPV 12.2, Platelet 191, Neutrophils 75.9, Lymphocytes 17.8, Eosinophils 2.4 Basophils.5, left shift +1, RBC normal, CRP Ultra Sensitive 2.9
My GP retested me & they came back higher he treated me for pnemonia (pneumonia), an inner ear infection in both ears & changed me to percodan. 10 days later he redid my blood work said the difference was not noticable, started me on new antibiotics for a bacterial infection. I had trouble swallowing & went to ER for alergy (allergy). They did xrays gave me benadril & said I was fine. When I returned to my GP he told me to take the meds with benadril. 4 wks later he sent me to have CT of chest, abdomen, and pelvis. The results "Numerous bilateral 3cm & smaller paraeptal & centrilobular bullae with a 2.5 focal area of groundglass opacity & 2 1cm nodes in my lungs, several nodes near jugular & abdomen w/enlarged liver & left ovary enlarged with numerous cysts approx 5 cm no nodes or free fluid." My GP redid my CBC (cultures normal):WBC 18.3, RBC 7.94 but other numbers were not signifigantly changed. I was sent to an Oncologist for lymphoma & was told I didn't have all the symptoms & sent back to my GP. It's been 6 months since my first CBC & my WBC is down to 15.2, RBC 5.85 HGB 16.2, HCT 47.8, MPV 10.8, Neut. 72.4, lymph. 19.5. For 3 months I've been off work due to fatigue, fever, infection, & pain. I'm on clindamycin now for strep and ears & was told they cant find anything so I'll have to just wait until the cancer or whatever shows up. What do I do now? Any ideas of things they may have overlooked?
Doctor's Answer
by Kevin Pho, MD, Jul 21, 2003 12:00AM
, Jul 21, 2003 12:00AM
Hello - thanks for asking your question.
I would inquire about a referral to a hematologist. With a persistantly elevated white blood count, I would want to make sure that leukemia is ruled out.
Here is a more complete list of what can elevate the white blood count:
- Any active inflammatory condition or infection
- Cigarette smoking, which may be the most common cause of mild neutrophilia
- Pregnancy and following uncomplicated spontaneous or cesarean delivery
- Previously diagnosed hematologic disease (such as acute and chronic leukemias, chronic myeloproliferative or myelodysplastic disease)
- The presence of, and treatment for, a chronic anxiety state, panic disorder, rage, or emotional stress (eg, post-traumatic stress disorder, depression)
- Recent vigorous exercise
- Recent thermal burn, electric shock, surgery, or trauma
- Presence of non-hematologic diseases known to increase neutrophil counts (eg, eclampsia, thyroid storm, hypercortisolism).
- Prior splenectomy or known asplenia
- Positive family history of neutrophilia
I would suggest a peripheral blood smear to make sure that there is no abnormality in the shape of the WBC's and RBC's. A bone marrow biopsy may be considered to ensure there is no blood disorder present.
As I have mentioned before, I would suggest a referral to a hematologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
I would inquire about a referral to a hematologist. With a persistantly elevated white blood count, I would want to make sure that leukemia is ruled out.
Here is a more complete list of what can elevate the white blood count:
- Any active inflammatory condition or infection
- Cigarette smoking, which may be the most common cause of mild neutrophilia
- Pregnancy and following uncomplicated spontaneous or cesarean delivery
- Previously diagnosed hematologic disease (such as acute and chronic leukemias, chronic myeloproliferative or myelodysplastic disease)
- The presence of, and treatment for, a chronic anxiety state, panic disorder, rage, or emotional stress (eg, post-traumatic stress disorder, depression)
- Recent vigorous exercise
- Recent thermal burn, electric shock, surgery, or trauma
- Presence of non-hematologic diseases known to increase neutrophil counts (eg, eclampsia, thyroid storm, hypercortisolism).
- Prior splenectomy or known asplenia
- Positive family history of neutrophilia
I would suggest a peripheral blood smear to make sure that there is no abnormality in the shape of the WBC's and RBC's. A bone marrow biopsy may be considered to ensure there is no blood disorder present.
As I have mentioned before, I would suggest a referral to a hematologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
