Blood Test Results: Concerns About Leukemia and Cholesterol Levels

Follow-up examination?

Hello, I have a follow-up appointment to discuss my blood test results and I would like to take some of your time to ask the doctor some questions.
On August 5, 2020, my lab results showed ALT 40, AST 22, Cholesterol 224, LDL 150, Neutrophils 26%, Lymphocytes 64%, Atypical Lymphocytes 4%, WBC 5.42.
Later, the doctor referred me to a hematology clinic and ordered additional tests.
The atypical white blood cells were absent, and the doctor mentioned that I do not have leukemia, so I shouldn't worry too much.
It was suggested that I might have had a viral infection, and I should return for another blood test in three months.
I apologize for the lengthy explanation, but I hope you can help clarify my concerns.

On August 17, 2020, my results were WBC 4.42, Neutrophils 33.7%, Lymphocytes 57%, ESR 1hr 13mm/hr, CRP 0.023 mg/dL.
During this follow-up to check my liver function and review the reports from both specialties, my family medicine doctor advised me to consult with the hematologist for their interpretation.

On November 2, 2020, my results were AST 17, ALT 27, Cholesterol 237, LDL 157, Neutrophils 27%, Lymphocytes 56%, Atypical Lymphocytes 3%, WBC 4.43.
I would like to ask the doctor if this really rules out leukemia, as the doctor mentioned not to worry, suggesting that I might have had a cold during the blood draw, which I was unaware of at the time.
I had my blood drawn on Monday, but by Friday, I had a sore throat and was diagnosed with a cold.
However, isn't a cold caused by a virus? I read online that elevated lymphocytes can indicate a viral infection.
The presence of atypical white blood cells is concerning to me; could they represent mutated cells? The doctor reassured me that there should be no issues, and if it were a cold, these numbers would normalize.
I was advised not to overthink it, to get plenty of rest, and to follow up in two to three months.
I would like to know if it is true that such abnormalities do not warrant significant concern.
Should I consider waiting until I am completely healthy and not feeling cold symptoms before my next blood test? The lab order states to have blood drawn seven days prior to the appointment; would it affect the results if I did it a few days earlier? The hematologist ordered a CBC with differential count this time but did not include ESR and CRP.
Is this because they were previously done and are not needed again? Lastly, regarding my cholesterol levels, the family medicine doctor suggested that I might be consuming too many eggs, but aren't eggs considered good cholesterol? Should I limit myself to one egg a day, or is it acceptable to have two to three occasionally?

Yue, 20~29 year old female. Ask Date: 2020/11/09

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
Based on your previous reports, the likelihood of a viral infection causing your cold is high.
Most colds are caused by viral infections, and a key characteristic of viral infections is an increase in lymphocytes and a decrease in neutrophils.
It is recommended to retest your blood cell count after recovering from your cold to confirm if it has returned to normal.
2.
Atypical white blood cells will increase with any infection, so their presence does not necessarily indicate anything specific.
3.
For your next blood draw, it is advisable not to do it too early.
I hope you can wait until you have fully recovered from your cold before having your blood drawn, as this will provide a clearer picture of your blood cell morphology without the influence of an active infection.
4.
ESR and CRP are general inflammatory markers and are only for reference.
It is not necessary to test them every time; the specific morphology of your white blood cells is more important based on your condition.
5.
There is no definitive answer to how many eggs one should eat in a day.
An increase in cholesterol levels is usually influenced by genetic and individual factors.
Thank you for your questions.

Reply Date: 2020/11/09

More Info

Understanding blood test results can be quite complex, especially when there are concerns about conditions like leukemia and cholesterol levels. Based on the information you've provided, let's break down the key components of your blood test results and address your concerns.

Blood Test Results Overview
1. White Blood Cell (WBC) Count: Your WBC count has been fluctuating around the normal range (approximately 4.42 to 5.42). A normal WBC count typically ranges from 4,000 to 11,000 cells per microliter of blood. Elevated WBC counts can indicate infections, inflammation, or more serious conditions like leukemia, but your counts are within normal limits, which is reassuring.

2. Differential White Blood Cell Count:
- Neutrophils: These are the most abundant type of white blood cells and are crucial for fighting off infections. Your neutrophil percentage has been around 26-33.7%, which is within the normal range (typically 40-75%).

- Lymphocytes: These cells are part of the immune system and help fight viral infections. Your lymphocyte percentage has been higher (around 56-64%), which can be indicative of a viral infection, especially if you had symptoms like a sore throat or cold.

- Atypical Lymphocytes: The presence of atypical lymphocytes can sometimes be concerning, as they may indicate a viral infection or other conditions. However, your doctor has reassured you that this is likely not indicative of leukemia, especially since you have no other concerning symptoms.

3. Liver Enzymes (ALT and AST): Your liver enzymes have been within normal limits, which suggests that your liver function is healthy. Elevated liver enzymes can indicate liver damage or disease, but your results do not show any cause for concern.

4. Cholesterol Levels: Your total cholesterol and LDL levels have been slightly elevated (Cholesterol 224, LDL 150). While dietary factors can influence cholesterol levels, it's important to consider your overall diet and lifestyle. Eggs can be part of a healthy diet, but moderation is key. The American Heart Association suggests that consuming one egg per day is generally safe for most people, but if you have other risk factors for heart disease, you may want to limit your intake.

Concerns About Leukemia
Your doctor has indicated that your blood test results do not suggest leukemia, especially since your WBC count is normal and there are no significant abnormalities in your differential count. It's understandable to feel anxious about the presence of atypical lymphocytes, but given your doctor's reassurance and the context of your recent viral infection, it seems that your results are more likely related to that rather than a hematological malignancy.

Recommendations
1. Follow-Up Testing: It’s wise to follow your doctor’s advice and have repeat blood tests in a few months. This will help monitor any changes in your blood counts and ensure that your health remains stable.

2. Timing of Blood Tests: Ideally, blood tests should be done when you are feeling well, as acute infections can skew results. If you feel unwell or suspect you might be coming down with something, it might be better to postpone the test.

3. Diet and Lifestyle: Continue to maintain a balanced diet and consider reducing saturated fats and cholesterol intake if your levels remain high. Regular exercise and a healthy lifestyle can also help manage cholesterol levels.

4. Stay Informed: Keep an open line of communication with your healthcare providers. If you have further concerns or if your symptoms change, don’t hesitate to reach out for additional testing or a second opinion.

In conclusion, while it’s natural to worry about blood test results, your current findings do not strongly indicate leukemia. Continue to monitor your health, maintain a healthy lifestyle, and follow up with your healthcare provider as recommended.

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