High wbc and neutrophils chronic and increasing over 5 months

[shae16]

I have had a chronic pattern of elevated wbc and neutrophils for 5 months now but only slightly elevated over those 5 months, however symptoms have increased and having extreme lethargy, night sweats and now daytime sweats and weakness. Most recent labs now show higher WBC 21 (range 4.5-11)and neutrophils 78 range (42-75) and low lymphocytes 13 (range 20-51). My doctor has me on 10mg of prednisone but he doesn’t feel the prednisone would increase my labs that much. Please help.

[Ken_PA]

Hi, I think right away we can dispense with Chronic Neutrophilic Leukemia since "CNL is an extremely rare disease. To date, the World Health Organization (WHO) has only reported approximately 200 patients who have been diagnosed with CNL."

I believe the WBC goes much, much higher in the common non-neutrophilic myeloid leukemias, btw.

So can WBC go as high as 21 from prednisone? Yes, but that degree of rise is more than average.

My father who had lymphoma and was sometimes put on prednisone got to around 20.

Here    https://www.ebmconsult.com/articles/glucocorticoid-wbc-increase-steroids     we have a review saying that there is a lot of *variability*, and "Some studies have shown increases in WBC counts greater than 20,000/mm3 ..."

Here's a study about variability "Prednisolone Pharmacokinetics and Pharmacodynamics in Relation to Sex and Race"     which also talks about estrogen levels:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207281/

10mg of prednisone isn't that large a dose; e.g., for immune suppression 60-80mg us used. Here, dosage is talked about     https://www.ncbi.nlm.nih.gov/pubmed/7304648  and also mentioned is that lymphocytes can be reduced (lymphopenia), which you also have.

So your level of neutrophila is possible from the steroid, though not average. Maybe you are just very reactive. But some of that might also be a reaction to infection. During infection, new neutrophils are rushed into production, and those new troops can be detected in a blood test as "bands" because they look different than the mature neutrophils ("segs"). Were those figures on your tests?

[Ken_PA]

From the above mentioned informal review: 'The above increases in neutrophils are made up by a small portion of immature (bands) WBC that predominately came from the bone marrow.  However, this contribution of bands does not usually cause the same degree of a "left shift" that is normally associated with presence of a bacterial infection.'

Then again, you haven't mentioned fever... or why you are being treated in the first place. Maybe you have some unusual immune dysfunction (but not leukemia) which creates all your problems -  if it was something common your doc would have diagnosed it by now..

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and come to think of it, I don't know what a CBC would look like in a myeloid leukemia, as opposed to lymphocytic which can go much higher.