15 y/o female w/ low WBC, elevated monocytes and low Neutrophils x2 years??

[bthatcher]

My daughter is 15, For the past 2 yers she has had a mildly decreased WBC, high Monocytes and low Neutrophils. She had a low titer positive ANA 1:40 previously as well. She is always fatigued, pale, she has morning stiffness and chronic mid back pain

[mkh9]

Hi, sorry about your daughter. We are not doctors on these forums. But, I am a microbiologist and will try to give you some advice. So the ANA titer isn't really positive.  1:40 is just the baseline dilution so that can be a false positive or low level titer. This is usually too low to call positive. Does she do any sports? Has she gone hiking in areas where there might be ticks or mosquitos? Have you had her iron level tested. What are her actual levels for her monocytes, lymphocytes, Total WBC, hemoglobin, RDW, and Neutrophil count and the labs normal ranges. You can either type them in here or post them on your site and remove her name and any personal information please.  Has she had any sore throat or swollen lymph nodes in the neck and or sore upper left abdomen? Any fever?
thanks,
mkh9

[bthatcher]

Hello, thank you for your response. We do live in a very rural area. She was tested for Lyme in 2012-ish which was negative at the time. She has a very intermittent sore throat which I usually chalk up to seasonal allergies give all the pollen and our animals. She plays volleyball on a comp team and dances. No fevers but the frequent hot flashes and flushing. Her lab levels seem to be on the line of normal but my concern is that it has been ongoing for the past 2 years or so.  WBC-3.5 (4.5-13.5), Mono%- 11.1 (0.0-8.0), Neut#-1.4 (1.8-8.4), Neut%- 37.9 (40-65), Hgb-13.3 (11-16.5), RDW- 12.2 (9.0-17.96). ESR is normal at 7 but alp is 46 (range 60-382). Iron studies seem to be ok.

[mkh9]

Sounds like she is getting sore throats maybe because her WBC count is low and Neutrophils. The question is why? Viral infections can do this. Medications can do this. Is she on any medications? The hot flashes and flushing sounds hormonal. You could either see a hematologist or since she is doing pretty well go by symptoms. Keep an eye on her and see if the levels change or she gets overly fatigued etc.  If so then perhaps see the hematologist and/or endocrinologist. I wouldn't want them to do a bone marrow they hurt. Unless it was really warranted.  Does she have normal periods? Or has she started those yet? There may be a link there. Just wondering or thinking out loud.
mkh9