Abnormal White Blood Cell Distribution: Should You Seek Further Testing?

Q: Abnormal White Blood Cell Distribution: Should You Seek Further Testing?

Hello： This number is abnormal, and you need to see a hematologist for further testing and other related examinations. <br>Thank you.

Is further examination needed for abnormal white blood cell distribution ratios?

Hello, doctor.
Since around the 20th of last month, I have been experiencing itching on my eyelids and palms, as well as mild urticaria or rashes on my face, behind my ears, and on my feet, which feels somewhat similar to mosquito bites.
These symptoms usually occur more frequently at night and are not persistent.
Additionally, I have woken up twice at night due to mild night sweats and feel slightly fatigued.
My body temperature has consistently been slightly higher than average (around 36.9-37.4°C).
I also have phlegm in my throat, which seems to be a long-term issue related to nasal congestion and post-nasal drip (the color is slightly yellow).
Yesterday, I visited a nearby clinic, and the blood test report indicated an issue with the distribution of white blood cells (lymphocytes and neutrophils).
The doctor explained that he was not quite sure why this was the case and speculated that it might be related to some infection, but he did not advise whether I should be referred to a specialist or if it was something minor that could be monitored.
This has left me somewhat concerned, and given the pandemic, I would prefer not to go directly to a regional hospital.
Therefore, I am reaching out to this website to inquire whether further examination is necessary or if I should just continue to monitor the situation.
Thank you, doctor! WBC: 6640, Neutrophils: 32.8% (normal: 40%-70%), Lymphocytes: 59.5% (normal: 18%-45%).

Roger, 20~29 year old female. Ask Date: 2022/06/15

Dr. Chen Yunfang reply Oncology

Hello: This number is abnormal, and you need to see a hematologist for further testing and other related examinations.
Thank you.

Reply Date: 2022/06/15

More Info

When interpreting blood test results, especially concerning white blood cell (WBC) counts and their distribution, it is essential to understand the context of the symptoms and the overall clinical picture. In your case, you have reported experiencing itching, mild rashes, night sweats, and fatigue, alongside a blood test showing an abnormal distribution of white blood cells, specifically a lower percentage of neutrophils and a higher percentage of lymphocytes.

Understanding Your Blood Test Results
1. White Blood Cell Count (WBC): Your WBC count is within the normal range (6640 cells/µL), but the distribution of the types of white blood cells is noteworthy. Neutrophils typically make up 40-70% of the total WBC count, while lymphocytes usually account for 18-45%. In your case, neutrophils are at 32.8%, and lymphocytes are at 59.5%. This shift can indicate several conditions, including viral infections, chronic inflammation, or even stress responses.

2. Symptoms: The symptoms you describe—itching, rashes, night sweats, and fatigue—can be associated with various conditions, including allergic reactions, infections, or even hematological disorders. The presence of yellow phlegm suggests a possible respiratory infection or chronic sinus issues, which could also contribute to your overall symptoms.

3. Possible Causes of Lymphocytosis: The elevated lymphocyte count could be due to:
- Viral Infections: Common viral infections can lead to an increase in lymphocytes as the body mounts an immune response.

- Chronic Inflammatory Conditions: Conditions like allergies or autoimmune diseases can also cause lymphocytosis.

- Stress: Physical or emotional stress can impact white blood cell distribution.

Should You Seek Further Testing?
Given your symptoms and the abnormal distribution of white blood cells, it is advisable to consider further evaluation. Here are some steps you might take:
1. Follow-Up with a Specialist: Since your primary care physician was uncertain about the implications of your blood test results, it may be beneficial to consult a hematologist or an infectious disease specialist. They can provide a more in-depth analysis and determine if further testing, such as a complete blood count (CBC) with differential, blood cultures, or specific viral panels, is necessary.

2. Monitor Symptoms: Keep track of your symptoms, including any changes in the rash, intensity of itching, frequency of night sweats, and overall fatigue. Documenting these can provide valuable information for your healthcare provider.

3. Consider Other Tests: Depending on the specialist's assessment, they may recommend additional tests, such as:
- Bone Marrow Biopsy: If there is a concern about blood disorders.

- Imaging Studies: To rule out any underlying infections or inflammatory conditions.

- Allergy Testing: If allergic reactions are suspected.

4. Lifestyle and Home Remedies: In the meantime, consider lifestyle modifications that may help alleviate your symptoms. Staying hydrated, managing stress, and ensuring adequate rest can support your immune system.

Conclusion
While your WBC count is within normal limits, the abnormal distribution of neutrophils and lymphocytes, combined with your symptoms, warrants further investigation. It is crucial to consult with a healthcare professional who can provide a comprehensive evaluation and guide you on the appropriate next steps. Early intervention can be key in addressing any underlying conditions effectively.

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