Low Lymphocyte Count: Your Blood Test Results and Next Steps

Q: Low Lymphocyte Count: Your Blood Test Results and Next Steps

Dear Ms. <br>Hsiao-Ling,<br>Your blood test report from the health check on December 4, 2019, shows that your white blood cell count is normal, but the proportion of neutrophils is slightly elevated at 76.6%, while the proportion of lymphocytes is somewhat low at 15.02%. <br>This

Low lymphocyte count: 0.912/nL

Hello Dr.
Chen,
On December 4, 2019, my blood test report from a health check showed the following results:
- Leukocyte: 6.09/nL (Normal: 3.9-10.2)
- MCHC: Low at 31.2 g/dL (Normal: 31.5-36.0)
- Lymphocytes: Low at 15.02%; 0.912/nL (Normal: 20-44%; 1.1-4.5)
- Monocytes: 7.2%
- Neutrophils: 76.68%; 4.678 nL (Normal: 42-77%; 1.5-7.7)
- Eosinophils: 0.7%
- Basophils: 0.4%
- RBC: 4.69/pl (Normal: 3.9-5.2)
- CRP: 3.53 (<5.0)
Medical history:
1.
At the time of the blood draw, I was experiencing a severe cold (approximately day six to seven).
I have about 1-3 severe colds per year, without any fever.
Each cold typically lasts about 8-12 days, and I have not taken any medication or seen a doctor.
I have no significant medical history and no symptoms of anemia.
2.
I also had a complete blood count in October 2018, which showed MCHC: 30 (low) and lymphocytes: 19% (low); 1.15 (normal), and I was not experiencing a cold at that time.
In 2017, all values were normal, but MCHC and lymphocyte counts were low (close to the lower limit of normal).
Previous records were all normal, but I recall they were on the lower side, as the doctor had inquired about any symptoms of anemia.
Unfortunately, I cannot find the original data.
Questions:
1.
I would like to ask if further testing is necessary (as I am studying in Europe, scheduling appointments with specialists and health insurance can take 1-2 months, and a referral from a doctor is required).
2.
I have consulted with a physician at a school health center, who suggested monitoring the situation since I have no discomfort or symptoms.
I am very concerned about the possibility of leukemia or other serious diseases, and I would like to hear your advice.
Thank you.

Xiao Ling, 30~39 year old female. Ask Date: 2020/01/06

Dr. Chen Bozhang reply Family Medicine

Dear Ms.
Hsiao-Ling,
Your blood test report from the health check on December 4, 2019, shows that your white blood cell count is normal, but the proportion of neutrophils is slightly elevated at 76.6%, while the proportion of lymphocytes is somewhat low at 15.02%.
This slight alteration in white blood cell differentiation indicates that your body may have been experiencing a mild infection or stress at the time of the blood draw, prompting your immune system to mobilize.
The degree of change is minimal, and as long as you are no longer experiencing severe cold symptoms, it is likely that your levels will return to normal.
If you currently have no physical symptoms, there is no need for concern or further medical evaluation.
Regarding MCHC, which stands for mean corpuscular hemoglobin concentration, your value of 31.2 g/dL is only slightly below the reference range.
If your hemoglobin (Hb), red blood cell count (RBC), and mean corpuscular volume (MCV) are all within normal limits, this represents a minor variation without clinical significance, and there is no need for concern.
If your Hb is low, then further investigation would be necessary to determine the cause of the anemia.

Reply Date: 2020/01/06

More Info

Interpreting blood test results can be a daunting task, especially when faced with abnormal values. In your case, the blood test from December 4, 2019, shows a leukocyte count of 6.09/nL, which falls within the normal range (3.9-10.2). However, the lymphocyte percentage is low at 15.02%, and the absolute lymphocyte count is also low at 0.912/nL (normal range: 1.1-4.5). The MCHC is slightly low at 31.2 g/dL (normal range: 31.5-36.0), while the neutrophil percentage is elevated at 76.68% (normal range: 42-77%).

Given that you were experiencing a severe cold at the time of the blood draw, it is important to consider the context of your symptoms. A viral infection, such as a cold, can lead to changes in white blood cell counts. Neutrophils typically increase in response to bacterial infections, while lymphocytes are often elevated in viral infections. In your case, the elevated neutrophils and low lymphocytes could indicate a response to the viral infection you were experiencing.

Your medical history shows that you have had recurrent colds but no significant underlying health issues. The fact that your lymphocyte count has been low in previous tests, even when you were not sick, suggests that this may be a chronic condition rather than an acute one. It is not uncommon for individuals to have variations in their blood counts without any underlying disease.

Regarding your concerns about serious conditions such as leukemia, it is essential to understand that a single blood test is not sufficient to diagnose such conditions. Leukemia typically presents with a combination of symptoms, including fatigue, unexplained bruising or bleeding, frequent infections, and significant changes in blood counts over time. Since you have no symptoms of concern and your leukocyte count is within the normal range, the likelihood of leukemia is low.

As for your questions:
1. Further Testing: Given that you are currently asymptomatic and your blood counts have been stable over the years, further testing may not be immediately necessary. However, if you continue to have low lymphocyte counts or if you develop new symptoms, it would be prudent to consult a healthcare provider for further evaluation. In your situation, it may be beneficial to monitor your blood counts over time rather than rushing into additional tests.

2. Observation: The advice from the healthcare provider at your school health center to observe your condition is reasonable. Since you are not experiencing any concerning symptoms and your blood test results are not drastically abnormal, it is appropriate to take a wait-and-see approach. If your lymphocyte counts remain low or if you develop any new symptoms, you should seek further evaluation.

In summary, while low lymphocyte counts can be concerning, they are not always indicative of a serious condition, especially in the context of a recent viral infection. Regular monitoring and maintaining open communication with your healthcare provider will help ensure that any potential issues are addressed promptly. If you have ongoing concerns, consider discussing them with a healthcare professional who can provide personalized advice based on your health history and current situation.

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