Blood Test Results: Concerns About Lymphocytes and Monocytes

Please ask questions regarding blood draws and related issues?

Hello Doctor, about a year ago, I started follow-ups in family medicine due to a liver enzyme level of 60.
I was advised to have blood tests every three to six months.
Later, during one of the tests, my lymphocyte count was 54%, with 3% atypical cells, which led my doctor to refer me to a hematology-oncology specialist.
I was very worried that I might have leukemia.
Subsequently, my lymphocyte count decreased to 45%, and the atypical cells disappeared.
I also had some tests for sedimentation rate and a C-related test, but my doctor reassured me that I shouldn't be too anxious; it wasn't leukemia and that the numbers were acceptable, so I continued with follow-ups.
In early May of this year, I had another blood test.
Although my lymphocyte count returned to normal, my monocyte count increased significantly, which made me very concerned.
I wondered if it was affected by the fact that I had a cold at the time of the blood draw, as I often seem to catch a cold or have an injury right before my tests.
I would like to ask the doctor what the general causes of elevated monocytes are and if it is dangerous.
Recently, aside from a slight sore throat due to staying up late while attending online classes abroad, I feel like I am on the verge of catching a cold after several nights of insufficient sleep, but resting helps.
Should I try to rest more and wait until I am healthier before having my blood drawn for more accurate results? I am concerned that having a cold might affect the types of cells in my blood.
Additionally, I noticed some minor skin breakdown under my tongue over the past week, but it healed after applying some oral ointment for about a day.
Seeing this data made me anxious, wondering if it could be related to AIDS, even though I previously tested negative at a major hospital.
I have not engaged in sexual activity yet, but with the skin breakdown under my tongue and the changes in my white blood cell count, I would like to ask the doctor if this could be related to AIDS.
I feel really helpless.
The previous doctor mentioned that such mouth sores are not just minor skin breakdowns and suggested that my late nights and weakened immune system could lead to inflammation and skin breakdown, but I am still very anxious.
I hope the doctor can address my two questions.
Thank you.
Here is part of the data: https://ibb.co/6By6cBQ

K, 20~29 year old female. Ask Date: 2021/06/04

Dr. Xiao Yongxun reply Family Medicine

1.
White blood cells are classified into neutrophils, eosinophils, basophils, lymphocytes, monocytes, etc., each with its own reference range.
2.
Their distribution can vary due to different diseases or physiological states.
Atypical lymphocytes may appear in peripheral blood during certain diseases or physiological responses, but if they return to normal after some time, it is generally not a concern.
3.
An increase in monocyte levels can occur in response to viral infections, bacterial infections, physiological reactions, etc.; if they normalize after a period, it is usually not a problem.
4.
The physician you consulted has already provided you with good management and advice.
5.
There are many causes of oral ulcers, the vast majority of which are benign; only a small percentage are related to oral cancer, HIV, autoimmune diseases, infections, etc.
However, based on your description, it should be benign and most likely caused by lack of sleep and insufficient immunity.
I hope you do not overexert yourself; getting adequate sleep along with a balanced diet should help improve your condition.
6.
If you have further concerns, please discuss them with your family physician for further evaluation.

Reply Date: 2021/06/04

More Info

Interpreting blood test results can be a complex process, especially when there are fluctuations in various blood cell counts, such as lymphocytes and monocytes. Your concerns about these changes, particularly in relation to potential conditions like leukemia or other hematological disorders, are valid and warrant careful consideration.

Firstly, let's break down the components of your blood test results. Lymphocytes are a type of white blood cell that plays a crucial role in the immune response. An increase in lymphocyte count can indicate various conditions, including viral infections, chronic inflammatory conditions, or, in rare cases, lymphocytic leukemia. However, your previous tests showed a decrease in lymphocyte percentage, which is a positive sign, indicating that your immune system may be stabilizing.

Monocytes, another type of white blood cell, are involved in the immune response and help in the removal of pathogens and dead cells. An elevated monocyte count can occur due to several reasons, including infections (especially chronic infections), inflammatory conditions, or stress responses. It's important to note that transient increases in monocytes can happen during or after an illness, such as a cold or flu, which you mentioned experiencing around the time of your blood tests. This could explain the elevated monocyte levels, especially if you were feeling unwell at the time of the test.

Regarding your concern about whether these changes could indicate a serious condition like AIDS, it's crucial to remember that AIDS is characterized by a significant decline in CD4 T lymphocytes, not necessarily an increase in monocytes or lymphocytes. Since you have previously tested negative for HIV, and given your lack of risk factors (as you mentioned you have not engaged in sexual activity), the likelihood of having AIDS is very low. The symptoms you described, such as a sore throat and the small ulcer under your tongue, could very well be attributed to stress, lack of sleep, or minor viral infections rather than a serious underlying condition.

Your doctor’s reassurance that your blood counts are not indicative of leukemia is important. Continuous monitoring and follow-up blood tests are essential to track any changes over time. If your lymphocyte and monocyte counts stabilize or return to normal ranges, it would further alleviate concerns.

As for your question about whether you should wait until you feel healthier to have blood drawn, it is generally advisable to be in a stable health condition when undergoing blood tests. Illness can affect blood cell counts, leading to results that may not accurately reflect your baseline health. Therefore, if you are feeling unwell, it might be beneficial to wait until you recover before your next test.

In summary, while fluctuations in lymphocyte and monocyte counts can be concerning, they are often influenced by temporary factors such as infections or stress. Regular follow-ups with your healthcare provider and open communication about your symptoms and concerns are key to managing your health. If you continue to experience symptoms or if your blood counts show significant changes, further evaluation may be warranted. Always prioritize your health and well-being, and don’t hesitate to seek medical advice when in doubt.

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