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Can I have mono with normal WBC?

Hello, I went to a Hematologist because my spleen was enlarged (19cm) on a CT scan I got while I was 7mo pregnant to evaluate for a PE (didn't have one). I wasn't able to get in to her office until 6 months after the CT scan, and when she did one my spleen had shrunk to 10cm. She did an EBV test and it showed current Mono infection, but my CBC showed normal WBC? It is now 1 month after my visit (7 months after swollen spleen) and my lymph nodes are still swollen big enough that I can barely swallow (they were not swollen while I was pregnant). WBC is still normal even though I still run a low fever once a week. Can I still have mono with normal WBC, and do you think that is why my spleen was swollen?

Background: 24yo white female, history of SVT & arthritis since 5yo. No medications & on prenatal vitamin only

Below are my lab results.

Antibody to nuclear RNP measurement (RNP ab) <1.0 NEG  
ANA titer, U/mL (Anti-nuclear ab titer, U/mL) <1:40  
(Chromatin (nucleosomal) ab) <1.0 NEG  
(NRBC, #/100 wbc) 0 #/100 wbc  
Granulocytes, immature, automated, % (IG %) 0.3%  
(NRBC %) 0 /100 wbc  
(MPV) 10.2 fL 7.4 || 10.4
Hemoglobin determination (HGB) 14.8 g/dL 12.0 || 16.0
Hematocrit determination (HCT) 41.3% 37.0 || 47.0
Mean corpuscular volume (MCV) 85.9 fL 81.0 || 99.0
(Platelet morphology) Normal  
Red cell distribution width determination (RDW) 12.6% 10.5 || 14.5
Mean corpuscular hemoglobin concentration determination (MCHC) 35.8 g/dL 33.0 || 37.0
Mean corpuscular hemoglobin determination (MCH) 30.8 pg 27.0 || 31.0
Platelet count (PLT) 255 x 10^3/uL 130.0 || 400.0
Basophil count (BA #) 0 x 10^3/uL 0 || 0.1
Eosinophil count (EO #) 0.2 x 10^3/uL 0 || 0.3
Monocyte count (MO #) 0.5 x 10^3/uL 0 || 1.0
Lymphocyte count (LY #) 1.8 x 10^3/uL 1.2 || 3.4
Neutrophil count (Neu # (ANC)) 4.9 x 10^3/uL 1.5 || 6.5
White blood cell count (WBC) 7.6 x 10^3/uL 4.8 || 10.8
Red blood cell count (RBC) 4.81 x 10^6/uL 4.2 || 5.4
Basophil, percent (BA %) 0.5% 0 || 1.0
Eosinophil, percent (EO %) 3.2% 0 || 3.0
Monocyte, percent (MO %) 7.2% 3.0 || 11.0
Lymphocyte, percent (LY %) 23.7% 15.0 || 41.0
Neutrophil, percent (Neu %) 65.1% 40.0 || 77.0
Plt Est (Platelet estimate) Agrees with Analasys

RBC Morph (manual) (RBC morph) Normal  
Unsaturated iron binding capacity measurement (Iron, % saturation) 28.52% 20.0 || 50.0
(EBV capsid ab titer, IgM) < OR = 0.90  

Chemistries (Comprehensive Metabolic Panel)

Creatinine measurement, serum (Creatinine) 0.8 mg/dL 0.6 || 1.3
Chloride measurement (Chloride) 102.2 mmol/L 97.0 || 107.0
Urea nitrogen measurement (BUN) 8.5 mg/dL 7.0 || 18.0
Sodium measurement (Sodium) 141.5 mmol/L 136.0 || 145.0
Calcium measurement (Calcium) 9.2 mg/dL 8.5 || 10.1
Alkaline phosphatase measurement (Alkaline phosphatase) 93 U/L 46.0 || 116.0
Albumin measurement (Albumin) 4.28 g/dL 3.4 || 5.0
Protein measurement (Total protein) 7.6 g/dL 6.4 || 8.2
Potassium measurement (Potassium) 3.72 mmol/L 3.5 || 5.1
Bicarbonate measurement (CO2) 30.6 mmol/L 21.0 || 32.0
Glucose measurement (Glucose) 97.8 mg/dL 74.0 || 106.0

Antibody to double stranded DNA measurement (ds-DNA antibody, quant) 43< complement assay (C3, serum) 122 mg/dL  
Complement assay, total (Complement CH50, total) 50 U/mL 31.0 || 60.0
Antibody to SS-B measurement (Sjogren's antibodies (SSB)) <1.0 NEG  
Antibody to SS-A measurement (Sjogren's antibodies (SSA)) 60  
Granulocytes, immature, automated (IG #) 0.02 x 10^3/uL  
(BUN/Creatinine ratio) 10.6  6.0 || 25.0
Bilirubin, total measurement (Bilirubin, total) 0.5 mg/dL 0.2 || 1.0
Aspartate aminotransferase measurement (AST/SGOT) 12.3 U/L 15.0 || 37.0
Albumin/Globulin ratio (A/G ratio) 1.3  0.8 || 2.0
Alanine aminotransferase measurement (ALT/SGPT) 24 U/L 14.0 || 59.0
Lactate dehydrogenase measurement (LDH) 131 U/L 81.0 || 234.0
(TIBC) 357.7 ug/dL 250.0 || 450.0
Globulin measurement (Globulin) 3.3 g/dL 2.2 || 4.2
(Iron / FE) 102 ug/dL 50.0 || 175.0
Angiotensin converting enzyme measurement (ACE) 12 U/L 9.0 || 67.0
(EBV panel interpretation) SEE NOTE  
(EBV VCA, IgG, Index) 3.71 Index  
(EBV nuclear ag (EBNA) ab, IgG, EIA) 2.4 EIA value  
Ferritin measurement (Ferritin) 20.5 ng/mL 15.0 || 200.0
(Sedimentation rate, Westergren) 2 mm/hr

4 Responses
1415174 tn?1453246703
Hi and sorry you are having these problems. We are not doctors on these sites but I am a microbiologist and can try to answer your questions.

Do you have your reference ranges for the EBV Capsid antibody titre IgM . It looks like the result is 0.90

same for the EBV VCA IgG I need the reference range and is the result 3.71?

Also for the EBV nuclear antigen (EBNA IgG) what is the reference range and is the result 2.4? It looks like these got cut off.

If the EBV Capsid Antibody IGM was positive then you may be one of rare adults who got mono. But you are still pretty young (24 years old).

Could you have normal white count? Normal no but if you were pregnant maybe yes because this makes your immune system compromised or low. So it may be possible. And, Yes swollen spleen and swollen lymph nodes are signs of Mono also you usually have a high fever during the worst of it and a very sore throat. Was your fever higher before? Did you have a bad sore throat too?

Other things can cause swollen lymph nodes and spleen but it depends on the results of that EBV Capsid antibody IgM.

Avatar universal
Thank you for replying mkh9.

EBV values are positive >1. So VCA and EBNA are both very positive. I was not pregnant when I got this bloodwork done, it was 6 months after having my baby.

I didn't get a sore throat until months after having my baby and I have had a low fever on and off for several months.

I don't think I'm getting over this very well and I'm afraid maybe my immune system is not good. My baby was sick all of a week and then he was fine. I just seem to be having a really hard time getting better.

1415174 tn?1453246703
Hi, so if the EBNA is positive and the VCA IGM is negative but the VCA IGG is positive it is past infection. This would mean you may have something else.

The EBNA does't come up with a new infection.  The spleen and lymph nodes can enlarge for a lot of infections that is their job.  Let me know if you have any questions.

1415174 tn?1453246703
p.s. the fact that your spleen and lymph nodes are enlarging shows your immune system is active. Also, with EBV usually you have a high fever not low grade and a very sore throat. You can be ill for  a month or two. It is really unusual not to have a high count of atypical lymphocytes as well (not monocytes despite the name mononucleosis). Once your lymph nodes and spleen are swollen it does take a month or two to go back to normal. Sometimes a little longer.  If the doctor was talking about the mono spot test being normal it doesn't mean anything. That test is worthless. I can give you many references if you like (including the CDC).

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