Any Doctors or Hematologist on Here? Just Had Some Abnormal Blood Test Results

ghsNick

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May 25, 2010
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I’ve been on this forum a long time and I wanted to see if there were any doctors or Hematologists that regularly visit that could help me out with some recent blood test.

- 28
- Male
- 6 Foot
- 165 Lbs
- Caucasian

My annual physical didn’t go as planned this year. When I went in I let my doctor know that my lymph nodes (multiple ones) felt a bit swollen under my neck and that my abdomen (in different places) had been aching for the last two weeks.

They decided to do some blood-work (CBC and CMP) and I got the results to the CBC immediately. If you look here, you can see that I have low WBC, RBC, Hemoglobin, Hematocrit, and Lymph. The CMP can be seen here, which came back normal for the most part (other than A/G ratio).

Now, after this scare I put together a chart of ALL my blood work from the last 8 years which can be seen here. As you can see, the CBC at my latest appointment is all messed up and has low WBC, RBC, Hemoglobin, Hematocrit, Lymph (and the Platelets really dropped off from my normal).

For the last 8 years my doctor has sent my blood work to the same lab to be reviewed (which normally takes 2 days), BUT, at this visit they did the CBC in their office in about 5 minutes. They actually sent the CMP away, which came back normal...so now I'm wondering if this could be a "bad" test or if my CBC is really that messed up?

Next steps are taking place this week -

- Get CT scan of my abdomen/pelvis and neck with contrast
- Meet with hematologist

Can anyone give me some insight into my situation? I'm obviously very scared of having leukemia or lymphoma...but my doctor mentioned I could be anemic, but I'm not so sure since my WBC is also down.

Any feedback would be greatly appreciated!

PS - I have been hit with very random "spells" of light-headedness that has probably taken place over the last 5 months. I'm not sure if that helps identify anything (in addition to the aching abdomen and swollen lymph nodes).
 

CLS1

macrumors member
Oct 29, 2017
62
70
I’ve been on this forum a long time and I wanted to see if there were any doctors or Hematologists that regularly visit that could help me out with some recent blood test.

- 28
- Male
- 6 Foot
- 165 Lbs
- Caucasian

My annual physical didn’t go as planned this year. When I went in I let my doctor know that my lymph nodes (multiple ones) felt a bit swollen under my neck and that my abdomen (in different places) had been aching for the last two weeks.

They decided to do some blood-work (CBC and CMP) and I got the results to the CBC immediately. If you look here, you can see that I have low WBC, RBC, Hemoglobin, Hematocrit, and Lymph. The CMP can be seen here, which came back normal for the most part (other than A/G ratio).

Now, after this scare I put together a chart of ALL my blood work from the last 8 years which can be seen here. As you can see, the CBC at my latest appointment is all messed up and has low WBC, RBC, Hemoglobin, Hematocrit, Lymph (and the Platelets really dropped off from my normal).

For the last 8 years my doctor has sent my blood work to the same lab to be reviewed (which normally takes 2 days), BUT, at this visit they did the CBC in their office in about 5 minutes. They actually sent the CMP away, which came back normal...so now I'm wondering if this could be a "bad" test or if my CBC is really that messed up?

Next steps are taking place this week -

- Get CT scan of my abdomen/pelvis and neck with contrast
- Meet with hematologist

Can anyone give me some insight into my situation? I'm obviously very scared of having leukemia or lymphoma...but my doctor mentioned I could be anemic, but I'm not so sure since my WBC is also down.

Any feedback would be greatly appreciated!

PS - I have been hit with very random "spells" of light-headedness that has probably taken place over the last 5 months. I'm not sure if that helps identify anything (in addition to the aching abdomen and swollen lymph nodes).
Good morning I came across your post while lurking through macrumors.

I am a Clinical Lab Scientist(diagnostic medicine) and have been practicing for the last 15 years. I must preface my comments by saying that I am not a Doctor. Although my speciality is in the medical lab.

First off:

CBC results will vary from facility to facility. A doctors office will not be as comprehensive and or accurate as a medical center. So variation is expected. I’m assuming your doctor decided to perform the test in house due to your chief complaints at the time. Had her/she decided to send out your sample, it would have possibly taken 2 days to get the results back therefore delaying your care.

Furthermore, without performing a peripheral smear. I can’t say whether or not there are any underlying issues. Without one it’s quite difficult for me to make any other determinations(immature cells, infection, etc..). But judging by the results I can tell you that your white count has been steadily declining, along with your Hgb/Hct. Hence the light headedness caused by the anemia. Depending on where your numbers are when you see the hematologist, they may decide to transfuse you.


Your ABSOLUTE (lymph#) low lymph count is in direct correlation with your white count. Meaning Low white count = less cells. So it’s not surprising your absolute lymph count is low.

But the percentage (lymph%) of lymph’s in your CBC is a 40%. Meaning 40% of the cells in your 2.8 white count were lymphs. I can tell you that normally in adults >25 years, a high lymph count is abnormal. That would be a sign of a viral infection. Again without a smear I can’t make an appropriate diagnosis.

The cause of your leukopenia could be a number of things, but that’s outside my scope of practice and best left for the MD.

Good luck and I hope I’ve helped you.
 
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ghsNick

macrumors 68030
Original poster
May 25, 2010
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Good morning I came across your post while lurking through macrumors.

I am a Clinical Lab Scientist(diagnostic medicine) and have been practicing for the last 15 years. I must preface my comments by saying that I am not a Doctor. Although my speciality is in the medical lab.

First off:

CBC results will vary from facility to facility. A doctors office will not be as comprehensive and or accurate as a medical center. So variation is expected. I’m assuming your doctor decided to perform the test in house due to your chief complaints at the time. Had her/she decided to send out your sample, it would have possibly taken 2 days to get the results back therefore delaying your care.

Furthermore, without performing a peripheral smear. I can’t say whether or not there are any underlying issues. Without one it’s quite difficult for me to make any other determinations(immature cells, infection, etc..). But judging by the results I can tell you that your white count has been steadily declining, along with your Hgb/Hct. Hence the light headedness caused by the anemia. Depending on where your numbers are when you see the hematologist, they may decide to transfuse you.


Your ABSOLUTE (lymph#) low lymph count is in direct correlation with your white count. Meaning Low white count = less cells. So it’s not surprising your absolute lymph count is low.

But the percentage (lymph%) of lymph’s in your CBC is a 40%. Meaning 40% of the cells in your 2.8 white count were lymphs. I can tell you that normally in adults >25 years, a high lymph count is abnormal. That would be a sign of a viral infection. Again without a smear I can’t make an appropriate diagnosis.

The cause of your leukopenia could be a number of things, but that’s outside my scope of practice and best left for the MD.

Good luck and I hope I’ve helped you.
Thank you so much for the response. You’re absolutely correct, they only did the labs in house because of my symptoms. I went back on Friday to get a repeat of the CBC (which they are sending out to the lab that normally does them) and I should have the results on Tuesday.

The hemotologist is also writing a script for specific blood test that I’ll have done by my first visit. Is it safe to assume (or should I ask) for the peripheral smear you’re recommending?

I have a question about the 40% Lymph number you mentioned...what’s a normal percentage? I understand you’re not diagnosing me, I’ll be getting that done this week, but are you saying my % of Lymph’s could be closely related to a viral infection (or not)?

I’m going to wait for what my doctor says but what are some best case/worst case scenarios here? Is there any hope that this could be related to some type of infection or something more serious?

Like I said, I appreciate your input as I’ll be seeing a doctor this week, but I’d like to have some expectations in mind so I’m not blindsided with anything.

Thanks,
Nick
 

Phonephreak

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Aug 24, 2017
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I work as a phlebotomist for almost 20 years. I have run thousands of cbcs in that time. You look to be pretty anemic for a male. Was the test run from a fingerstick or a venous draw? Wait for the repeat blood work to verify.
 

ghsNick

macrumors 68030
Original poster
May 25, 2010
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I work as a phlebotomist for almost 20 years. I have run thousands of cbcs in that time. You look to be pretty anemic for a male. Was the test run from a fingerstick or a venous draw? Wait for the repeat blood work to verify.
It was run from my arm. Only difference (compared to all my bloodwork) is they did it in office vs sending out to the lab that normally does it.

Luckily I got a redraw on Friday (should have results on Tuesday and this week I’m getting a CT scan of the neck/abdomen...and visiting hematologist next week.

Really hoping this can correct itself or it was an error with the quick on the spot testing.
 

CLS1

macrumors member
Oct 29, 2017
62
70
Thank you so much for the response. You’re absolutely correct, they only did the labs in house because of my symptoms. I went back on Friday to get a repeat of the CBC (which they are sending out to the lab that normally does them) and I should have the results on Tuesday.

The hemotologist is also writing a script for specific blood test that I’ll have done by my first visit. Is it safe to assume (or should I ask) for the peripheral smear you’re recommending?

I have a question about the 40% Lymph number you mentioned...what’s a normal percentage? I understand you’re not diagnosing me, I’ll be getting that done this week, but are you saying my % of Lymph’s could be closely related to a viral infection (or not)?

I’m going to wait for what my doctor says but what are some best case/worst case scenarios here? Is there any hope that this could be related to some type of infection or something more serious?

Like I said, I appreciate your input as I’ll be seeing a doctor this week, but I’d like to have some expectations in mind so I’m not blindsided with anything.

Thanks,
Nick
The peripheral smear is a procedure performed by the CLS working in Hematology at that time. Think of it as a reflex test. So for instance upon analyzing your CBC should the CLS see something abnormal on the printout. The CLS would would perform a peripheral smear to manually look for abnormalities manually that the analyzer would have otherwise looked over.

So the short answer is yes, i'm sure a peripheral smear will be done in your case.

Normal range for lymphocytes in adults >25 is around 20-40% so you fall within range so to speak.

In regards to you having an infection, again hard to say without a smear. If you look at the print out you provided. You have a few more values in that Auto-differential. Specifically GRA% 49.2 and Lymph%40.1. This would be considered a normal differential. BUT again without a smear i'm just guessing.

You have to understand that our white blood cells have a lineage. Lymphocytes are not just lymphocytes. You have atypical lymphocytes, reactive lymphocytes, any of which in large numbers could be indicative of something underlying. Then you have Granulocytes which would include white cells like Segmented neutrophils, Eosinophils, basophils, etc. again depending on what majority is representative of that 49.2% its hard to tell. But i can tell you having a larger number of mature cells(granulocytes) vs immature cells (lymphocytes) is good(aside from your low white count.)

Leukopenia can be caused by a number of things. Again outside my scope of practice. It could be one thing or a combination of things. I would need to see your patient history, other lab results to make a more educated reply. I'd hate to say one thing and you find out otherwise, id feel terrible. I'm sure you can understand that.

Again good luck to you, I hope you hear "good" news in the days to come.
 
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ghsNick

macrumors 68030
Original poster
May 25, 2010
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The peripheral smear is a procedure performed by the CLS working in Hematology at that time. Think of it as a reflex test. So for instance upon analyzing your CBC should the CLS see something abnormal on the printout. The CLS would would perform a peripheral smear to manually look for abnormalities manually that the analyzer would have otherwise looked over.

So the short answer is yes, i'm sure a peripheral smear will be done in your case.

Normal range for lymphocytes in adults >25 is around 20-40% so you fall within range so to speak.

In regards to you having an infection, again hard to say without a smear. If you look at the print out you provided. You have a few more values in that Auto-differential. Specifically GRA% 49.2 and Lymph%40.1. This would be considered a normal differential. BUT again without a smear i'm just guessing.

You have to understand that our white blood cells have a lineage. Lymphocytes are not just lymphocytes. You have atypical lymphocytes, reactive lymphocytes, any of which in large numbers could be indicative of something underlying. Then you have Granulocytes which would include white cells like Segmented neutrophils, Eosinophils, basophils, etc. again depending on what majority is representative of that 49.2% its hard to tell. But i can tell you having a larger number of mature cells(granulocytes) vs immature cells (lymphocytes) is good(aside from your low white count.)

Leukopenia can be caused by a number of things. Again outside my scope of practice. It could be one thing or a combination of things. I would need to see your patient history, other lab results to make a more educated reply. I'd hate to say one thing and you find out otherwise, id feel terrible. I'm sure you can understand that.

Again good luck to you, I hope you hear "good" news in the days to come.
Thanks. I’ll keep you posted on how everything goes in case I have any other questions or next steps from the hematologist.
 

ghsNick

macrumors 68030
Original poster
May 25, 2010
2,657
531
Good luck
The peripheral smear is a procedure performed by the CLS working in Hematology at that time. Think of it as a reflex test. So for instance upon analyzing your CBC should the CLS see something abnormal on the printout. The CLS would would perform a peripheral smear to manually look for abnormalities manually that the analyzer would have otherwise looked over.

So the short answer is yes, i'm sure a peripheral smear will be done in your case.

Normal range for lymphocytes in adults >25 is around 20-40% so you fall within range so to speak.

In regards to you having an infection, again hard to say without a smear. If you look at the print out you provided. You have a few more values in that Auto-differential. Specifically GRA% 49.2 and Lymph%40.1. This would be considered a normal differential. BUT again without a smear i'm just guessing.

You have to understand that our white blood cells have a lineage. Lymphocytes are not just lymphocytes. You have atypical lymphocytes, reactive lymphocytes, any of which in large numbers could be indicative of something underlying. Then you have Granulocytes which would include white cells like Segmented neutrophils, Eosinophils, basophils, etc. again depending on what majority is representative of that 49.2% its hard to tell. But i can tell you having a larger number of mature cells(granulocytes) vs immature cells (lymphocytes) is good(aside from your low white count.)

Leukopenia can be caused by a number of things. Again outside my scope of practice. It could be one thing or a combination of things. I would need to see your patient history, other lab results to make a more educated reply. I'd hate to say one thing and you find out otherwise, id feel terrible. I'm sure you can understand that.

Again good luck to you, I hope you hear "good" news in the days to come.
I just got amazing news today! My second blood test came in (the one that they sent to the lab vs doing in-house) and it came back completely normal!!!

Here are the results.

I literally feel like I have a new lease on life. This new blood test was taken two days later, so there’s no way these figures changed that much in two days, right? The first test had to of been bad with the in-house equipment or not calibrated properly?

All I know is I’m thanking God right now for this awesome news!
 
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Phonephreak

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Wow. Huge difference. New one looks great.
Only thing I could think of is mixup with blood or maybe it started to clot. This would give odd results. Glad it worked out.
 

ghsNick

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Original poster
May 25, 2010
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Wow. Huge difference. New one looks great.
Only thing I could think of is mixup with blood or maybe it started to clot. This would give odd results. Glad it worked out.
Thanks for the feedback.

To be clear, the “bad” one was done in office and took about 10 minutes. The “good” result was sent away to another lab and was processed the next day (aka how they’ve always done my blood).

Are you saying blood clotting would cause my “bad” numbers or my “good” numbers? There’s no way I got a false set of “good” numbers on the one sent away, right?
 
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Phonephreak

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Aug 24, 2017
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I’m saying that the first tube could have clotted somewhat. There is a anticoagulant in the tube. If it’s not mixed throughly it could start to clot. This would cause readings that weren’t correct.
This is a purple top tube

The CMP has to clot. The test is run on the serum from your blood specimen. This is a red top tube or possibly a green top. Depends on the machine they use to run the tests.
 

ghsNick

macrumors 68030
Original poster
May 25, 2010
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Got it!

Yes, I see LabCorp processed my newest “good” bloodwork from my doctor’s office..and I trust them A LOT more than whatever my doctor has set up in-house lol.

I think I need a beer or glass of wine for dinner :cool:
 
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