Low neutrophils, high lymphocytes

[Chery222]

My 13 year old son's absolute neutrophil count has been low for at least 10 months starting at 1.72 in November and now to 8.8.  HIs absolute lymphocyte count has been high ranging from 2.47 to 3.99 and now 2.64.  WBC have been normal until now it is a little low, 4,64.  He has fatique, headaches and paleness a lot.  This month his Monocytes were high, 14, for the first time.  Is this anything I should be concerned about?  The doctor said it was probably a virus but we have been dealing with him not feeling well for almost a year.  

[Voja1234]

Hello everyone,

I have came up this tread by days searching the net. And came up to some similarities whit problem that i currently face. In short one year ago i have been diagnosed with Mononucleosis caused by the EBC lGl results was 152. I have had increased lymphocytes around absolute number 8.000 and relative around 70%. I have had increased liver and spleen...after few weeks I got better and my liver enzymes returned to normal. I just have diagnosed Gilbert syndrome and 2 polyps in my gallbladder. One year after on a regular check up i have notices my lymphocytes were still high 57% or around 4.000 absolute count, neutrophils around 32% . I have been to doctor and she said i look fine no swollen lymph nodes no signs of any disease. Even dough six months after infection my spleen was marginal size.

Do you think it is possible that this blood results are the consequence of Mononucleosis i have had or, it might be something more serious. I feel fine without any symptoms. Thanks

[AskAli]

Did they ever check your son to see if he was IgG Deficient and/or suffering from CVID (Common Variable Immune Deficiency)? It often overlaps with autoimmune disorders, as well as Leukemia and/or Lymphomas. Most children with IgG Deficiency grow out of it. But it should be looked at and treatment considered.

[DrHPowers]

Mono EBV can cause chronic low neutrophils.  It can also be an inherited pattern.

[allen171]

54 yr old, memory issues, night sweats, severe fatigue, feverish, runny eyes, blurry vision, cough. labs: WBC 11,000, platelet 474 (H), neutrophil% 39 (L), lymphocyte 40 (H), lymphocytes-absolute 4.9 (H), glucose 103 (H),cholesterol 203 (H) prevastatin sodium 40mg 1x daily, ldl, cholesterol 136 (H), any ideas, thank you, vikki

[janna77]

thank you so much chery to share this information with us and im so happy that your son is ok and i hope that he stay that way
happy for you
and thank you so much for answering my question

[janna77]

hi ken
we don't leave in a high altitude we live near san francisco CA.
and i believe she is getting enough iron

and i press in her spleen i believe its soft so really im confused. i googled a little and i found that low MCV  and high RBC can be cause by thalassemia

and ken we did't get an other CBC maybe we will during the week so im gonna  post the result a soon as we get them

thank u so much you are such a help, thank u soooooooooo much so nice of you

[Mochadelicious]

I am so glad that he finally has a diagnosis (as I'm sure you are as well).  Not knowing is the hardest part, and now that you know what it is, you can focus on getting him better.  I've never heard of autoimmune neutropenia, but it just goes to show that there are so many blood diseases out there and trying to interpret blood labs and what they mean is nearly impossible for the untrained person.  

Can you please explain what autoimmune neutropenia is and what kind of treatments are required when blood levels require it?  This information may be helpful for others who may be experiencing similar symptoms.  Thanks Chery and I hope you continue to check in and keep us posted on your sons progress.

[Chery222]

Hi Everyone,
Sorry I did not reply right away.  My son had his bone marrow which came back clean.  They have diagnosed him with autoimmune neutropenia.  Possibly caused by a virus at some point.  They said that they will probably never know what is causing it and there are no other tests they feel are necessary.  They are just going to have his PCP monitor his bloodwork periodically.  I do feel confident that his hematologist ran every test they could at this point.  Right now we are just going to have his bood watched and hope he stays healthy.  Right now he feels pretty good most of the time but does start to feel lousy if he gets run down.  I hope are able to get a diagnosis soon.  It is soooo frustrating.  

[Ken_PA]

That would be "spleen", of course.

Also, I'd want to be sure that an actual person has looked at a slide of her blood - not that only a machine did it.

Also, when a person looks at her white blood cells, they can probably rule out leukemia.

If you get another CBC today, please post the results. You should get a copy immediately.

[Ken_PA]

Some viruses van keep nodes swollen for years, e.g. "chronic Epstein Barr"

I had noticed the elevated RBCs, I assume that if her RBCs are small (microcytic) and shaped wrongly (ovalocytosis), then her system makes more of them to keep up the supply of oxygen in her blood. (If a person goes to live at a high altitude where oxygen is low, then they make more RBCs.)

Is she getting enough iron in her diet?

I'll stress this which I'd posted earlier: "...some people may have crises in which the red blood cells rupture, especially if they have a viral infection."

In other words, if she has a condition of hereditary ovalocytosis, then a virus makes it worse.

Did you press on her speen? (below ribs on left side)

[janna77]

i forgot she has also a high RBC

[janna77]

we have just a family history of blood cancer in my mother side and my father side and liver cancer, and the swollen lymph nodes are in both sides of her neck, 2 in etch side and the 2 are close, about the deficiency of B12 and folic acid i dont think so, for how long do you think for a virus  to clear up? so we can have an other blood test and see whats gonna happen
and thank u so much for helping its really nice of you

[Ken_PA]

Do you have any reason to suspect a deficiency in vitamin B12 or folic acid?

Any history of coeliac disease?

[Ken_PA]

Well, ovalocytosis (oval-shaped RBCs, instead of the usual round-donut shape) is uncommon as far as I know, except in certain ethnic populations. Are you a descendant of people from Southeast Asia or Africa?

The first thing anyone would think of when seeing elevated lymphocyte counts is a virus infection - because that's what lymphocytes normally do, they multiply to fight viruses. When they multiply inside lymph nodes, they make lymph nodes swell. A virus can also cause a reduced number of neutrophils. But I don't know of how a virus would cause abnormally shaped RBCs. (Maybe it can do that, but I haven't read anywhere that it can.)

Everything I see about ovalocytes says that it is only ever hereditary. It's not caused by cancer. So that's a plus.


http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001589/

"Expectations (prognosis)

Most persons with hereditary elliptocytosis have no problems, and are unaware of their condition.

Complications

Elliptocytosis is frequently harmless. In mild cases, fewer than 15% of red blood cells are elliptical-shaped. However, some people may have crises in which the red blood cells rupture, especially if they have a viral infection. Persons with this disease can develop anemia, jaundice, and gallstones."


That's all very encouraging. Maybe your daughter had the condition (of oval/elliptical RBCs) all the while, but it was only discovered because docs are investigating her swollen nodes.

Do you have a family history of autoimmune diseases? Bad allergies? Very bad mono? These are signs of a possibly very reactive immune system. Having nodes swollen for 4 months from an infection is rare, but still possible.

Those are my guesses. Here is another (but I'm much more familiar with lymphoma than ALL): having enlarged nodes from ALL without really high WBC counts is probably not usual. That'd be from a more advanced condition. I don't think your daughter's WBC number is really high.

You might as well also press on her spleen and see if it's tender.

Are all of the swollen nodes near to each other?

All of the replies in this thread are very helpful and they show the wide variety of symptoms and possible causes.

[janna77]

ok ken i will try to send her an e mail, so do you have any idea about the reason of the abnormality in red blood cells, thank u so much

[Ken_PA]

Hi, Emma. I'd suggest writing to Chery222 directly and that might increase the chances that she'll notice. The part that stands out to me is the similar abnormalities that are found in the Red Blood Cells.

[janna77]

hello
i have read all the comment and im really interested because my daughter has some lymph node around her neck and has low neutrophils and high lymphocytes, i hope your son is ok, what the result say about the bone marrow biopsy?

[Mochadelicious]

I think a bone marrow biopsy would be very helpful, although I can tell you that after I was diagnosed with lymphoma via lymph node biopsy, they decided to do a bone marrow biopsy to see if it had spread there too.  The results: my bone marrow was 100% clean.  So my point is it is possible to have lymphoma and not have it in the bone marrow.  Leukemia might be different though.  I'm not as familiar with that.

I'm keeping my fingers crossed that you start getting some real answers soon and the bone marrow biopsy sheds some light on what is going on.

[Chery222]

I definitely understand what you are going through.  We are on our 2nd Hematologist.  My son had an appointment 2 weeks ago and the Hematologist said that they may never know the exact reason for the low neutrophils and other abnormal blood work.  She feels it is autoimmune and they can't always find out why.  She is willing to do the bone marrow.  My son will have it in a couple of weeks.  She really feels it will not show anything but she is willing to do it because we are anxious about his blood levels.  She said if the cells are normal levels in the bone marrow (where all the cells are made), then they will know that someting is happening to the blood after it leaves the bone marrow, which is autoimmmune a lot of the time.  It is so frustrating!

[Hope4diagnosis]

I have been reading this post about your son. I hope they have found the reason for his symptoms. It is the most frustrating thing waiting and searching for a diagnosis. My daughter went through the swine flu at 15. She was very ill. She recovered from it but from then on began having very bizarre symptoms such as swollen joints with heat and pain, swollen lymph nodes, headaches, extreme fatique, anemia, and slightly abnormal blood problems. In July, her hemoglobin was 3. I was horrified! The doctors just had her on over-the-counter iron tablets. She has had low platelets at times, low hemoglobin, her B12/serum is extremely high (she eats no foods containing this as she doesn't like them), currently her neutrophils are slightly low and her lymphocytes are extremely high. She has bruising and petechiae at various times. We have been to every kind of "ologist" there is and have cast 2 hemotologist/oncolgists to the curb! We are now at another oncologist/internal med doctor. Not one doctor was willing to do a BMA on my daughter! The thing is when they do a CBC, it always comes back normal. Her PCP ignores that test and always does further testing on her blood which shows the abnormalities. The hematologist take that test at face value. It has been 3 years now and still no diagnosis. I have watched my child go from a happy, fun loving, outgoing teen to staying at home, resting all the time, and always feeling bad. She is now on meds for anxiety as well. I am at my wits end with doctors! The current oncologist is taking her seriously and has seen the blood abnormalities. She may have a diagnosis for my daughter soon and may do the BMA next week hopefully. After all this time, my daughter is about to lose her healthcare coverage. She turns 19 next month and that ends the coverage. We are so concerned. I hope your son's diagnosis comes soon. I understand the pain you are in dealing with it all and watching your son suffer.

[Chery222]

Hi Teresa,
Thank you so much for all you have explained to me about your son.  I really appreciate it.  You have been through a lot.  We will be going back to the Heamtologist in 3 weeks.  I will keep you posted.  
Take care,
Cheryl

[railroaded]

My son's name was David. He got sick about 2 months earlier, and he looked pale and was tired, they checked him for everything, and everything, even leukemia, came back negative....because they couldn't extract cells from his bone marrow, he had "dry taps", I don't know what the real name is, it was what everyone just called them, they said the cells were too sticky to extract. He was at UCSF, and gradually got better, within 3 weeks, but I could tell he was still sick, and within that 3 week period EVERYTHING had been ruled out.. Within a month he presented within one afternoon with Acute lymphoblastic Leukemia, and a neutrophil count of 0 (ZERO!). He had been being checked weekly during that month we went back home and even though his counts were abnormal, now that I can read them, it wasn't until that one afternoon he just was going to die...and that is what WOULD have happened, if I wouldn't have questioned the on-call doctor who had been arrested for a DUI, and was always drunk! I hope your son has just low counts, and I know it IS unusual for a child to have chronic leukemia, they usually present very fast with Acute, but my son DID get sick a couple of months earlier, and he was hospitalized, and when I look at photos from5-6 months earlier he DID look pale, but he was always so unusually active, I didn't notice him slowing down, until much later. I wish you the best of luck, and I would recommend a good hemotologist or a pediatric Oncologist, preferably at a teaching hospital, they have seen everything. I am praying for your son, really.  Teresa

[Chery222]

My sons anti-neutrophil antibody test came back negative.  Now we wait and see the next step.  

[Chery222]

@just4me1...yes he has been checked for mono and EBR, both negative.  They have also ruled out Hodgkin's, Addison's, anemias.  I feel like I know what you are going through.  I also had mono, very bad, when I was 19.  Now at 47 and for the past 10 years I have suffered from fatigue, joint pain, and headaches, and noone can figure it out.
Thank you all for posting.  It makes me feel better being able to talk about my son while we try to figure it out.  I worry all the time and hopefully it is something that is not serious.