Elevated White Blood Cell and Platelet Counts: Risks and Monitoring

Q: Elevated White Blood Cell and Platelet Counts: Risks and Monitoring

Hello： Based on your information, your white blood cell count is slightly higher than normal, while your platelet count is somewhat lower (45-60, what is the unit?). <br>Is that correct? Generally speaking, clinical physicians would typically suspect you might have MDS (Myelodysp

Blood cell issues?

I have had elevated white blood cell and platelet counts for a long time, with white blood cells currently around 13,000 to 17,000 and platelets between 45,000 and 60,000, while all other parameters are normal (without any illness).
I have undergone two bone marrow examinations; the first showed 5.5% blast cells, while the second had no blast cells but indicated increased marrow cellularity.
My physician advised that I must be closely monitored.
I do not have a congenital condition causing high blood cell counts; they were normal before I started working at a gas station.
I have noticed a gradual increase in blood cell counts over the years, starting with white blood cells between 11,000 and 13,000 and normal platelets.
My grandfather passed away from acute myeloid leukemia (AML).
I have asthma but only occasionally require steroids; I usually use a bronchodilator.
Given my slow, gradual increase in blood counts, what is the likelihood that this could develop into leukemia? How long should I continue to be monitored? Thank you!

chun, 30~39 year old female. Ask Date: 2015/12/18

Dr. Chen Yunfang reply Oncology

Hello: Based on your information, your white blood cell count is slightly higher than normal, while your platelet count is somewhat lower (45-60, what is the unit?).
Is that correct? Generally speaking, clinical physicians would typically suspect you might have MDS (Myelodysplastic Syndromes), and your first bone marrow report supported that suspicion, but the second one did not (may I ask if you have received subcutaneous Azacitidine chemotherapy treatment?).
Whether AML (Acute Myeloid Leukemia) is hereditary is still uncertain; I have indeed seen cases where both a mother and daughter were diagnosed with AML within a year of each other, but such familial occurrences are quite rare.
Regarding your concerns about the possibility of progressing to leukemia, I would like to inform you that if it is MDS, a portion of individuals (about 20-30%) may develop leukemia over their lifetime.
However, predicting who will deteriorate is influenced by many factors, including chromosomal abnormalities, the number of blasts, and the subtypes of MDS, among others.
I would recommend that you have blood tests every three months to monitor your condition, and if there are significant changes in your blood profile, a repeat bone marrow biopsy would be very important! Thank you for your inquiry!

Reply Date: 2015/12/18

More Info

Elevated white blood cell (WBC) and platelet counts can be concerning, especially when there is a family history of hematological malignancies such as acute myeloid leukemia (AML). Your situation, characterized by persistently elevated WBC counts ranging from 13,000 to 17,000 and platelet counts between 45 and 60, warrants careful monitoring and evaluation.

Understanding Elevated WBC and Platelet Counts
1. White Blood Cell Count: Normal WBC counts typically range from 4,000 to 11,000 cells per microliter of blood. Your counts, being consistently above this range, indicate leukocytosis. This can be due to various factors, including stress, infection, inflammation, or more serious conditions like myeloproliferative disorders or leukemia.

2. Platelet Count: Normal platelet counts range from 150,000 to 450,000 platelets per microliter of blood. Your reported platelet counts of 45 to 60 (assuming these are in thousands) suggest thrombocytosis, which can occur in response to inflammation, iron deficiency, or bone marrow disorders.

Risk Factors and Family History
Given your family history of AML, it is understandable to be concerned about the potential for developing a hematological malignancy. While having a family history of blood cancers can increase your risk, it does not guarantee that you will develop a similar condition. The gradual increase in your WBC counts over time, especially if it is not accompanied by significant symptoms, may suggest a chronic process rather than an acute one.

Monitoring and Follow-Up
Your physician's recommendation for regular monitoring is crucial. Here are some key points regarding follow-up:
- Frequency of Monitoring: Regular blood tests every 3 to 6 months can help track any changes in your blood counts. If there are significant changes or if you develop new symptoms, more frequent monitoring may be warranted.

- Bone Marrow Evaluation: Since you have undergone two bone marrow examinations, the findings are essential. The presence of blasts (immature blood cells) in the first test and their absence in the second is a positive sign, but the overall cellularity and morphology of the bone marrow should be interpreted by a hematologist.

- Symptoms to Watch For: Be vigilant for any new symptoms such as unexplained bruising, bleeding, fatigue, fever, or recurrent infections, as these may indicate a progression of disease.

Potential Outcomes
While the risk of progression to leukemia exists, especially in cases of myelodysplastic syndromes (MDS) or other myeloproliferative disorders, many individuals with elevated WBC and platelet counts do not develop leukemia. The risk factors include:
- Cytogenetic Abnormalities: Certain chromosomal changes can increase the risk of transformation to leukemia.

- Blast Cell Percentage: A higher percentage of blast cells in the bone marrow is associated with a greater risk of progression to acute leukemia.

Conclusion
In summary, while your elevated WBC and platelet counts, along with your family history, raise valid concerns, it is essential to maintain a proactive approach through regular monitoring and follow-up with your healthcare provider. Early detection and intervention can significantly improve outcomes. Always communicate any new symptoms or concerns with your healthcare team, as they can provide tailored advice and management strategies based on your specific situation.

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