Low White Blood Cell Count and Elevated LDH Levels

Low white blood cell count, elevated LDH?

Hello, doctor.
Recently, I had a check-up at the clinic in June, where my white blood cell count was 4,200, with neutrophils at 46% (highlighted in red), lymphocytes at 42.6% (highlighted in red), monocytes at 7.4%, eosinophils at 2.8%, and basophils at 1.2% (highlighted in red).
In July, I had another check-up at the hospital, where my white blood cell count returned to 9,800, with neutrophils at 68.7%, lymphocytes at 22.7%, monocytes at 6.4%, eosinophils at 1.7%, and basophils at 0.5%.
My LDH level was also elevated to 150.
In September, I returned to the clinic for another check-up, and my white blood cell count decreased to 3,800 (highlighted in red), with neutrophils at 46.3% (highlighted in red), lymphocytes at 41.7% (highlighted in red), monocytes at 7%, eosinophils at 4.2%, and basophils at 0.8%.
My LDH level was also elevated to 283 (highlighted in red).
The doctor mentioned that there is inflammation in the lymph nodes and insufficient immunity, which is concerning.
Could you please tell me if there are any signs of leukemia or lymphoma?

Kai, 30~39 year old female. Ask Date: 2023/09/14

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Looking solely at the blood cell count from a blood test is not very accurate.
I would recommend that a hematologist examine your lymph nodes, as the diagnosis of lymphoma requires at least a physical examination of the lymph nodes.
Additionally, if it were leukemia, there would be abnormal white blood cells present in the blood.
Although your white blood cell count may vary, they are all normal white blood cells, so the likelihood of leukemia is very low.
Regarding the elevated LDH levels, it is not a specific test for diagnosing blood disorders and should be evaluated in conjunction with other test results, so I suggest you do not worry too much.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about you.

Reply Date: 2023/09/14

More Info

Low white blood cell (WBC) counts, particularly when accompanied by elevated lymphocyte percentages and high lactate dehydrogenase (LDH) levels, can be concerning and warrant further investigation. Your recent lab results indicate fluctuations in WBC counts, with values dropping to 4200 and then rising to 9800 before falling again to 3800. The lymphocyte percentage has also varied, with elevated levels noted in your initial and final tests. LDH levels have been notably high, peaking at 1509 and then dropping to 283.

Possible Causes of Low WBC Count and Elevated Lymphocytes
1. Viral Infections: Elevated lymphocyte counts often suggest a viral infection, as lymphocytes are crucial for the immune response against viruses. Common viral infections include Epstein-Barr virus (EBV), cytomegalovirus (CMV), and even COVID-19.
2. Chronic Inflammatory Conditions: Conditions such as autoimmune diseases can lead to changes in WBC counts and lymphocyte ratios.
3. Bone Marrow Disorders: While less common, certain bone marrow disorders, including leukemia and lymphoma, can present with low WBC counts and altered lymphocyte levels. Elevated LDH can also be a marker of cell turnover or tissue damage, which is seen in malignancies.

4. Nutritional Deficiencies: Deficiencies in essential nutrients like vitamin B12, folate, or iron can lead to hematological abnormalities, including low WBC counts.

5. Medications: Certain medications, particularly those that suppress the immune system (like chemotherapy agents), can lead to low WBC counts.

Elevated LDH Levels
LDH is an enzyme found in many tissues throughout the body, and elevated levels can indicate tissue damage or disease processes. High LDH levels can be associated with:
- Hemolysis (destruction of red blood cells)
- Liver disease
- Certain cancers, including lymphomas and leukemias
- Myocardial infarction (heart attack)

Concerns About Leukemia or Lymphoma
Given your symptoms and lab results, it is understandable to be concerned about the possibility of leukemia or lymphoma. However, diagnosing these conditions requires more than just blood tests. A definitive diagnosis typically involves:
- Bone Marrow Biopsy: This test can provide direct information about the bone marrow's health and the presence of abnormal cells.

- Imaging Studies: CT scans or PET scans can help identify any enlarged lymph nodes or other abnormalities.

- Further Blood Tests: Additional tests, including flow cytometry or cytogenetic analysis, can provide more information about the nature of the lymphocytes.

Recommendations
1. Consult a Hematologist: Given the complexity of your symptoms and lab results, it would be prudent to consult a hematologist. They can perform a thorough evaluation and recommend appropriate tests.

2. Monitor Symptoms: Keep track of any new symptoms, such as unexplained weight loss, night sweats, or persistent fatigue, and report these to your doctor.

3. Healthy Lifestyle: While awaiting further evaluation, maintain a healthy lifestyle. This includes a balanced diet rich in vitamins and minerals, regular exercise, and adequate sleep to support your immune system.

4. Follow-Up Testing: Regular follow-up blood tests may be necessary to monitor your WBC counts and LDH levels over time.

In conclusion, while your lab results raise some concerns, they do not definitively indicate leukemia or lymphoma. A comprehensive evaluation by a specialist is essential for an accurate diagnosis and appropriate management.

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