Haematology panel

[IM05]

---

Members do not see this ad.

If an asymptomatic subject presents with low WBC count of say 3.2 is it significant ? how far do you investigate ?

Thanks for your view/s.

 

[Bobblehead]

This reminds me of an algorithm that I saw pinned up for the workup of hyponatremia which started off as you'd expect but all lines ended at "call renal consult".

"Call hematology consult."

 

[IM05]

I am just expecting some opinions as to what level( how low WBC) would concer anyone ? .. because to me this is not a concern in an othewise normal individual..

 

[RuralMedicine]

Do you have a differential for your CBC?
Is the pt. neutropenic? lymphopenic?
Are the other cell lines intact (red cells, platelets)?
Do you have any comparison values?
What is your clinical exam?
Why did you obtain the CBC in the first place?

Depending on the above you can target digging a little deeper or perhaps no further workup is needed. This should be done before calling your friendly neighborhood hematologist.

 

[IM05]

Rural Medicine--Here are the answersp:
Neutrophil count is 0.9
Hb is normal
Platelet count is normal
P/E is insignificant
It was a health maintenance check-up, hard to get comparison values of the past, however good thought we could call the PCP about it.

The question is does this warrant a BM Biopsy. I would wait a month or two.

(This subject is 30-40 yrs of age)

 

[Bobblehead]

If you're seriously concerned the next step should be to examine the peripheral smear. Erroneous values are also high on the differential for an otherwise unexplainable lab value in an otherwise healthy individual so repeating the CBC should be done before any further evaluation is conducted. Medications can also cause myelosuppression as can leukemia but let's not go there yet.

 

[IM05]

Bubble head, if it is BM suppression, don't you think the RBC and Platelet count would go down as well.. 😕

 

[Surfer75]

Yep, lots of meds can induce leukopenia, but you may want to investigate the potential of immunosuppresion in this patient given he/she seems neutropenic at 0.9. In general, a mildly leukopenic patient who's not neutropenic would just be followed if the rest of the work up is benign. Further investigations should be sought if the cytopenia progresses or begins to involve more than one cell line.

S

 

[jashanley]

A hgb of three is a concern.........theoretically he should be symptomatic unless he has been slowly trending down over a long, long time and has grown accustom to it. Below 7, it becomes a strain on anyone's heart no matter who it is healthy or not. I'm very surprised.
I would start with a peripheral smear and start work it up.....I would not ignore it, especially with other lines down. MDS comes to mind.

 

[ERMudPhud]

A hgb of three is a concern.........

😕

I think he said wbc=3 ANC=0.9 all other lines normal. Repeat the CBC first with a smear before you get too worried

 

[ac808]

African Americans tend to run lower wbc counts normally, just in case this helps.

 

[IM05]

CBC was repeated with almost same results, yes it was only the WBC and the Neutrophil count that were abnormal, the rest are fine.

I can' t recall the race of the patient 'cos she is an outpatient. But, how does the race influence the count 😕 😕

 

[Annette]

You might want to do a retic count (poor man's bone marrow). Have you asked about risk factors for HIV? Any history of immune deficiencies? Any recent use of steroids?

 

[Adawaal]

Any anti-epileptic drugs on board? Tegretol in particular is infamous for this. Nearly everyone who takes this drops the white count. Not to mention the hyponatremia.... 🙄