Low White Blood Cell Count and Abnormalities in Cancer Care

Q: Low White Blood Cell Count and Abnormalities in Cancer Care

Hello： 1. The white blood cell count is unremarkable. You can decide whether to seek medical attention; if so, you should consult a hematologist. 2. Similarly, if you choose to seek medical attention, you can also see a hematologist. 3. These abnormalities

Low white blood cell count with abnormal differentiation?

I am concerned about not wanting to frequently visit the hospital and occupy medical resources, but I also worry that if there is a real issue, it may delay treatment.
Therefore, I would like to ask Dr.
Chen whether my situation requires further examination.

Examination data: In 2022 and early 2023, two tests showed slightly low white blood cell counts, but I did not record the data.
On September 2023, WBC was 2.99 k/uL (normal range: 3.25–9.16), and basophils were 1.7% (normal range: 0.2–1.6).
In December 2023, WBC was 3.90 x 10^3/uL (normal range: 4.0–10.0), and basophils were 2.0% (normal range: <1).
All other tests for red blood cells and platelets were normal.
Other blood tests (September 2023) showed: Blood Urea Nitrogen: 33 (normal range: 7–25), Glomerular Filtration Rate (GFR): 67 (normal range: 60–9999), Creatinine (CRE): 0.91 (normal range: 0.6–1.3), Chloride: 108 (normal range: 98–107), Aspartate Aminotransferase (GOT/AST): 20 (normal range: 8–31), Alanine Aminotransferase (GPT/ALT): 16 (normal range: 0–41), Alkaline Phosphatase (Alk-P): 42 (normal range: 34–104), Gamma-Glutamyl Transferase (r-GT): 7 (normal range: 9–64).
A resting electrocardiogram (September 2023) was normal.
An echocardiogram (July 2023) was normal, showing only mild mitral and tricuspid regurgitation.
A 24-hour Holter monitor (December 2021) showed only a few premature contractions and slight right axis deviation.
Blood pressure typically ranges from 100 ± 10 systolic and 50+ or 60+ diastolic, with a pressure differential of 40–60.
Tumor markers (September 2023): Gastric cancer CA72-4: 9.67 (normal range: 0–6.89), Non-small cell lung cancer Cyfra 21-1: 5.18 (normal range: <3.3).

Self-reported symptoms: For 365 days a year, I have phlegm in my throat (mostly in small amounts, white and not very sticky; on average, I experience sore throat and increased phlegm, which becomes thick and light yellow or light red about once a month).
Bruising without clear cause occurs on average about once a month, mostly around the knee joints, occasionally on the calves, and sometimes around the elbows.
These bruises do not resemble typical injuries (which occur at bony protrusions), but are more common in fleshy areas, usually slightly less than 1 cm near joints and slightly larger than 1 cm on the calves, with 2–5 appearing at a time, occasionally more than 5.
Recently, they have all faded away.
Regardless of how long it has been since lunch (sleep is normal, averaging 7 hours a day, waking up naturally), I often feel sleepy during static afternoon activities (reading, watching TV, etc.), needing to engage in actions like note-taking to stay awake.
I do not smoke or drink alcohol, have not taken any oral medications in the past year, and only use topical medications for dermatological issues (eczema, fungal infections).

My questions are: Do the tumor markers and persistent phlegm in my throat indicate that my body is in a state of mild inflammation? If so, why are my white blood cell counts still low? What could be the reasons for slightly low white blood cell counts and elevated basophils? Do I need further examinations? If so, which specialty should I consult? Given that my platelets are normal but I continue to have unexplained bruising, what could be the cause? Should I see a doctor the next time I experience bruising? If so, which specialty should I consult? My GFR is above 60, CRE is normal, and GOT and GPT are normal, but my blood urea nitrogen and chloride levels are elevated.
What could be the cause? Do I need further examinations? If so, which specialty should I consult? Which of the above abnormal indicators need continuous monitoring? How often should I follow up? I appreciate your guidance and assistance.
Thank you very much.

Liu Xiaojie, 60~69 year old female. Ask Date: 2023/12/19

Dr. Chen Yunfang reply Oncology

Hello: 1.
The white blood cell count is unremarkable.
You can decide whether to seek medical attention; if so, you should consult a hematologist.
2.
Similarly, if you choose to seek medical attention, you can also see a hematologist.
3.
These abnormalities do not have any particular significance.
4.
The two abnormal tumor markers are not utilized clinically in hospitals; they are likely commercial testing items.
Can they be used as a reference? I'm not sure, as your complaints do not have any clinical specificity; there could be issues, or it could just be an overreaction.
Additionally, the blood tests seem to be part of a standard testing package from the laboratory, which is quite unusual! Thank you.

Reply Date: 2023/12/19

More Info

Understanding low white blood cell (WBC) counts and their implications in cancer care can be quite complex, especially when considering the various factors that can influence these numbers. Your concern about the potential for serious underlying conditions, including blood cancers, is valid, but it’s essential to approach this with a clear understanding of what low WBC counts may indicate and the appropriate steps to take.

Firstly, a low white blood cell count, or leukopenia, can arise from numerous causes, including infections, autoimmune diseases, bone marrow disorders, nutritional deficiencies, and the effects of medications or treatments like chemotherapy. In your case, the WBC count of 2.99 k/uL in September 2023 is below the normal range (3.25–9.16 k/uL), while the count of 3.90 k/uL in December is slightly above the lower limit but still within a concerning range. The elevated basophil percentage (1.7% and 2.0%) could indicate an allergic reaction or a chronic inflammatory process, but it is not typically associated with serious conditions like cancer.

The fluctuation in your WBC count over a few months is not uncommon. Various factors, including stress, infections, and even the time of day when the blood is drawn, can affect these results. It is crucial to consider the overall clinical picture, including symptoms and other laboratory findings. Your normal red blood cell and platelet counts are reassuring, as significant abnormalities in these areas often accompany more severe hematological conditions.

Regarding your tumor markers, elevated levels of CA72-4 and Cyfra 21-1 can indicate the presence of malignancy, but they are not definitive on their own. These markers can be influenced by various benign conditions, and their interpretation should be done in conjunction with imaging studies and clinical evaluations. Persistent symptoms such as phlegm production and unexplained bruising warrant further investigation, as they could indicate underlying inflammatory or hematological issues.

Given your concerns about low WBC counts and the presence of symptoms, it would be prudent to consult a hematologist. They can perform a thorough evaluation, including a complete blood count (CBC) with differential, and possibly a bone marrow biopsy if indicated. This will help determine if there is a primary bone marrow disorder or another underlying cause for your symptoms and blood count abnormalities.

In terms of managing your health, maintaining a balanced diet rich in vitamins and minerals, particularly B vitamins and folate, can support healthy blood cell production. Staying hydrated, managing stress, and avoiding known toxins (like tobacco and excessive alcohol) are also beneficial.

As for the unexplained bruising, while your platelet count is normal, it may be worth discussing with a healthcare provider, especially if it recurs frequently. A hematologist can assess whether there is an underlying clotting disorder or other hematological issue.

In summary, while low WBC counts can be concerning, they are not always indicative of cancer or severe disease. A comprehensive evaluation by a specialist is the best course of action to determine the underlying cause and appropriate management. Regular follow-ups, especially if symptoms persist or worsen, are essential to ensure any potential issues are addressed promptly.

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