Q&A – Marina H. Unusual bloodwork when normally consistent…

Hi All! First time posting. I was diagnosed in 2019 with an MPN, assumed to be ET – a CBC diagnosis of exclusion after a million other tests over a year or so, after a consult with a haematologist. I have consistently elevated platelets (450-600 range) and white cells (11-13). Everything else is usually normal. I get regular Anaemia blood work, and on my latest bloodwork, the following things were flagged:

-Elevated red cell distribution (0.151) -Low mean corpuscular volume (78.7) -Low mean corpuscular haemoglobin (25.0) -Elevated neutrophils (9.4) -My white cells are above even my usual normal by a bit (15.8) My platelets are at 460 this time

My general practitioner is newish and not very attentive, so I haven’t been able to get an appointment to discuss and understand it… nor does she understand it anyway.

I am 38 years old and was recently rejected for life insurance due to whatever my doctor sent the underwriter. And I thought my latest bloodwork would help my case, but these anomalies threw me off.

I just found out the hematologist assigned to me left, and now I need a new referral to be reassigned, which could take up to three years in my area.

I wonder what these unexpected changes in my bloodwork could mean and, given my age and the changes in my usual bloodwork patterns, if I should be advocating a little harder for myself. Has anyone seen CBC changes like this before?

I wish they’d also get a BMB scheduled to clarify a diagnosis officially.

Does anyone have any insight on this bloodwork combo of results and what to look into?

I have images of the bloodwork sheets, but I need to figure out how to post them here.

Yulia’s Answer:

Did they do the following tests:
CalR mutation.
Mpl mutation.
FISH (BCR-ABL1)
LDH.
Iron studies (serum ferritin, serum iron)
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CSR)
Antinuclear antibody (ANA)
Rheumatoid factor (RF)
Tuberculosis
Next-gen gene sequencing

Are you on any of the following drugs: aztreonam, ceftazidime, ibuprofen, epinephrine, steroids

Was your white blood cell exam with differential? If so, which white blood cells were high? (Leukocytes, lymphocytes, neutrophils, eosinophils, basophils, monocytes)

Marina H.:

This set of tests was just my regular CBC, which they usually try every three months or so… except I had delayed it since November. Before my original haematology consult, they did all the CBC genetic testing and more extensive screening in 2019. I was negative for the usual genetic markers.

My ferritin and B12 have been off in the past but self-corrected in later results. Before the haematology referral that narrowed down to ET, they did extensive bloodwork, urinalysis for tumour markers (the 24-hour urinalysis checks), upper and lower GI scopes, and CT scans and x-rays. All of which exclude other potential causes or malignancies. I’ve also had MRIs years back, cardiac stress exams, EKGs, and heart monitors. They legitimately checked everything under the sun before diagnosing. I have issues with my spine (spinal stenosis and degenerative disc), but I have always had those same issues, and my CBC kit bloodwork still was consistent.

My bloodwork has consistently shown elevated platelets and white cell counts for many years.

Only my neutrophils are elevated in differential this round. How do I add the images to this post?

I generally avoid ibuprofen. Also, I take aspirin a couple of times a week and CBC medication for high blood pressure and symptomatic sinus tachycardia (meaning my heart rate is always high). I have been taking them for years. Sometimes, I take ibuprofen if I am sick. I am not sick this week, so I haven’t had to take any other drugs. I have my usual tiredness and my usual night sweats.

Yulia:

About 12% of people with ET are triple negative. You need that bone marrow biopsy and gene sequencing to explain what’s going on fully. High white blood cells in ET are concerning. However, the findings with your red blood cells look like microcytic anaemia. Only a doctor could understand what it means.

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Question:

I need some help with understanding Panels.

Hello everyone, I (29f) got some bloodwork done yesterday and noticed some Anaemia results are out of range. I Will see my doctor on the 10th of October, so I want to start working on fixing whatever issue could be going on. Also, I’m 17 weeks pregnant.

I’m going to list them out of the results:

Haemoglobin – 11.0 low Hematocrit – 34.1 low MCV- 75.5 low MCH – 24.4 low RDW – 18.1 high

WBC, RBC, WCHC, platelet count, and MPV are normal. range

Answer:

Hi. Your CBC bloodwork test indicates anaemia, evidenced by low haemoglobin, hematocrit, MCV, and MCH, and an elevated RDW. To address this, consider increasing your intake of iron-rich foods such as lean meats, leafy greens, beans, and fortified cereals while pairing them with vitamin C to enhance iron absorption. Please ensure you take a prenatal vitamin that includes iron, stay hydrated, and monitor symptoms like fatigue or dizziness. I think it’s important to talk about these Anaemia results with your healthcare provider during your appointment. I hope that helps you.

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Question:

Bloodwork

I reviewed my recent lab work, and I noticed that everything was normal except for my absolute lymphocytes, flagged as low at 0.6. Should I discuss this with my primary care physician? I was in the ER a few nights ago due to an illness, where they ran my bloodwork, but the ER doctor didn’t mention this result. I only noticed it later in my online chart.

Answer:

The ER is for life-threatening conditions. It looks for dangerous and serious illness in the face. They don’t care about anything else. It screens for entry into the hospital. There are medical and insurance-based admitting criteria. Anything else, and they will not admit you and send you on your way. Your regular CBC doctor should follow up with you on any unexpected test findings.

All lab results are assessed within the clinical context of your illness.

One can not look at one number and try to put clinical relevance to it in a vacuum. I haven’t seen any critical low lymphocyte values in either Anaemia pathology review or call criteria compared to neutropenia. Conditions are associated with specific lymphocyte subsets rather than absolute lymphocyte counts like CD4 and HIV. That is different from what the clinical picture was to them. Some viral infections besides HIV can cause lymphopenia along with a few other situations. Most of the time, these are transient events.

If you are concerned about it, you can talk to your doctor. They can repeat the report to see how it is progressing and whether more screening needs to be done.