Blood Test Results: What Your Doctor Might Be Concerned About

Follow-up data and related issues?

Hello, Doctor.
I actually visited a family medicine clinic this morning because my liver enzyme levels were at 40 and my cholesterol was slightly over 200, so I have been following up every three months.
However, this time the doctor suddenly suggested that I be referred to a hematologist.
Although she said not to worry too much, I am still quite anxious.
After visiting the hematology-oncology department today, I was asked several questions, had my abdomen tapped, my neck examined, my throat opened, and my eyes checked as if they were looking for something.
They also drew blood, and I had four vials taken.
I vaguely remember the tests ordered, which included ESR, CML, and AML, but I forgot one of them.
I can only return for a follow-up next Monday.
This morning, I almost cried and asked the doctor if I had cancer or something similar.
Although the doctor smiled and said I was too anxious and that it might just be an infection, I couldn't help but worry.

Regarding my lab results:
Neutrophils: 26.0
Lymphocytes: 64.0
Monocytes: 1
Eosinophils: 5
Basophils: 0
Atypical Lymphocytes: 4.0
I understand that the components of white blood cells can vary, but the total should equal 100%.
However, the first three values are too low, too high, and too low, and I’m unsure if having only 1 Monocyte is unusual.
Additionally, atypical lymphocytes were not present in my previous tests.
Although the hematologist mentioned not to worry and that it likely indicates an infection, I would like to know your opinion on what these results generally indicate.
Thank you, Doctor!

Bai Bai, 20~29 year old female. Ask Date: 2020/08/17

Dr. Hong Yuanbin reply Internal Medicine

Hello, as you mentioned, these values are all types of white blood cells, and they add up to 100%.
Your main concern is that the lymphocyte ratio is too high, while the neutrophil/segment ratio is too low, along with the presence of atypical lymphocytes (a.lym).
This situation can have many potential causes.
Considering your age, the likelihood of various conditions, from highest to lowest, includes: viral infections, mycoplasma infections, mycobacterial infections, other atypical infections, hematologic malignancies, and parasitic infections.
There are numerous possible causes, which is why your physician has ordered a series of tests, including ESR and CRP, which are markers for inflammation and infection.
Overall, if this was discovered during a routine check-up and you have no other symptoms, the likelihood of cancer is very low; it is more probable that you have a viral infection, such as a cold.
However, everything still needs to be evaluated during your follow-up appointment with a comprehensive assessment of other values.
Thank you for your question.

Reply Date: 2020/08/17

More Info

Interpreting blood test results can be a daunting task, especially when faced with potential concerns about serious conditions like cancer. It's important to remember that blood tests are just one piece of the puzzle in diagnosing health issues. In your case, the referral to a hematologist (blood specialist) suggests that your primary care physician wants to ensure that any underlying blood disorders are thoroughly evaluated.

From the results you provided, we can break down the key components:
1. White Blood Cell (WBC) Count: Your total WBC count is crucial as it helps assess your immune system's status. Normal ranges typically fall between 4,000 and 11,000 cells per microliter. Your count appears to be within normal limits, but the breakdown of the types of white blood cells is what raises some questions.

2. Differential Count:
- Neutrophils (Neut.seg.): A count of 26.0% is low. Neutrophils are the body's first line of defense against infections, and a low percentage may indicate a risk for infections.

- Lymphocytes (Lympho.): At 64.0%, this is elevated. Lymphocytes are crucial for immune responses, particularly viral infections. An increase can sometimes indicate a viral infection or other conditions.

- Monocytes (Mono): At 1%, this is low. Monocytes help in the immune response and their low count may not be significant on its own.

- Eosinophils (Eos): At 5%, this is within normal limits. Eosinophils are often elevated in allergic reactions or parasitic infections.

- Basophils (Baso): At 0%, this is not unusual as basophils are typically present in very low numbers.

3. Atypical Lymphocytes: The presence of atypical lymphocytes can be concerning as they may indicate a viral infection or, in some cases, a more serious condition. However, the absence of blasts (immature cells) is a positive sign, as their presence can indicate leukemia or other malignancies.

4. Concerns About Cancer: It’s understandable to feel anxious about the possibility of cancer, especially when referred to a specialist. However, the hematologist's reassurance that it might just be an infection is a good sign. Many conditions can cause changes in blood cell counts, including infections, stress, and even recent vaccinations.

5. Next Steps: It’s essential to follow up with the hematologist as planned. They may conduct further tests, including a complete blood count (CBC) with differential, bone marrow biopsy, or additional imaging studies, depending on their clinical judgment.
6. Managing Anxiety: While waiting for results can be stressful, try to focus on what you can control. Maintain a healthy lifestyle, manage stress through activities you enjoy, and seek support from friends or family.

In summary, while your blood test results show some abnormalities, they do not definitively indicate cancer. The hematologist will provide a more comprehensive evaluation and guide you through the next steps. Remember, many conditions can cause changes in blood tests, and the majority are treatable. Stay positive and proactive in your health journey.

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