Blood Test Results: Changes in White Blood Cell Counts and Allergies

Inquiry about blood test report values?

Hello, Doctor.
I had blood tests done on January 8 and July 4 of this year, and overall the values were normal.
The only concerning changes were in the white blood cell differential: neutrophils decreased from 52.5% to 37.3%, and lymphocytes increased from 38.7% to 54.1%.
Additionally, I received my COVID-19 vaccinations, completing the first two doses before October 1 last year, and I received the third dose on January 25 this year.
I am unsure if these changes in numbers indicate any warning signs from my body.

Since the end of January, I have been experiencing unexplained hives and red discoid lesions that have persisted for over six months without improvement.
I have consulted a dermatologist and have been taking antihistamines, but they have not been very effective.
The symptoms fluctuate, especially when the discoid lesions appear, which typically take about 2 to 3 days to resolve.
I also underwent allergy testing, but no specific allergens were identified.
Should I consult a different specialty for more detailed examinations? Additionally, I am curious if this could be related to the COVID-19 vaccination.
Thank you for taking the time to respond!

Ke Ke, 30~39 year old female. Ask Date: 2022/07/15

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
The COVID-19 vaccine is still relatively new, which may lead to a higher chance of side effects, and there are various symptoms that can occur after vaccination.
However, most of these are temporary, so there is no need to worry too much.
The changes in the ratio of neutrophils to lymphocytes that you mentioned can occur after vaccination or viral infection, and generally, it is sufficient to monitor these changes over time.
Additionally, skin symptoms that arise after vaccination may be related to the vaccine, but they could also be triggered by an underlying allergic predisposition following vaccination.
These distinctions will require long-term follow-up to clarify.
I recommend consulting a rheumatologist or immunologist for further evaluation.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to assist you.

Reply Date: 2022/07/15

More Info

Understanding blood test results can be quite complex, especially when it comes to interpreting changes in white blood cell (WBC) counts and their implications for health. In your case, you've noted a significant shift in your blood test results between January 8 and July 4, specifically in the percentages of neutrophils and lymphocytes. Let's break down what these changes might indicate and how they relate to your symptoms and recent vaccination.

Changes in White Blood Cell Counts
1. Neutrophils and Lymphocytes:
- Neutrophils are a type of white blood cell that plays a crucial role in fighting off infections, particularly bacterial infections. A decrease from 52.5% to 37.3% could suggest a relative increase in other types of white blood cells or a decrease in neutrophil production or survival.

- Lymphocytes, on the other hand, are primarily involved in the immune response, particularly against viral infections. An increase from 38.7% to 54.1% indicates that your body may be responding to a viral infection or an immune challenge.
2. Clinical Context:
- These changes in WBC counts can be influenced by various factors, including infections, stress, medications, and vaccinations. Given that you received your COVID-19 vaccine in October and a booster in January, it's possible that your immune system is reacting to the vaccine, which could explain the increase in lymphocytes.

Symptoms of Urticaria and Discoid Rash
Your ongoing symptoms of urticaria (hives) and discoid rash are concerning, especially since they have persisted for several months. Urticaria can be triggered by various factors, including allergens, medications, and even infections. The fact that you have not found a specific allergen through testing suggests that your condition may be idiopathic (without a known cause) or related to other underlying issues.

Next Steps
1. Consultation with Specialists:
- Given your symptoms and the changes in your blood test results, it may be beneficial to consult with an allergist or immunologist. They can perform more comprehensive testing to identify potential triggers for your urticaria and assess your immune function more thoroughly.

- A dermatologist may also be helpful, especially for the discoid rash, to evaluate whether it is related to an autoimmune condition or another dermatological issue.

2. Monitoring and Follow-Up:
- Continue to monitor your symptoms and any changes in your blood test results. Keeping a symptom diary can help you and your healthcare providers identify patterns or triggers.

- If your symptoms worsen or new symptoms arise, seek medical attention promptly.

Connection to COVID-19 Vaccination
While there is no direct evidence linking your symptoms to the COVID-19 vaccine, vaccines can sometimes provoke immune responses that may lead to transient changes in blood counts or trigger autoimmune reactions in susceptible individuals. However, these occurrences are generally rare.

Conclusion
In summary, the changes in your white blood cell counts, particularly the decrease in neutrophils and increase in lymphocytes, could reflect an immune response, possibly related to your vaccination or another underlying condition. Your persistent symptoms of urticaria and discoid rash warrant further investigation by specialists. It is essential to maintain open communication with your healthcare providers to ensure a comprehensive approach to your health concerns.

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