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Can someone please explain, "plasmacytoid lymphocytes and reactive lymphocytes"?
On my CBC, I noticed at a note that reads "few plasmacytoid lymphocytes and reactive lymphocytes." What does this mean? Is this something that I should be concerned about? Is this a normal finding? What is a plasmacytoid lymphocyte?
Lymphoplasmacytic lymphoma gets its name because the lymphoma cells have characteristics of both lymphocytes and plasma cells. It is an uncommon type of B-cell non-Hodgkin lymphoma (NHL). Lymphoplasmacytic lymphoma usually occurs in older adults. The average age at diagnosis is 60. It is usually slow growing (indolent).
Hi, I came across the conversation trail above while I was searching for explanation on the blood test that I had to take as a result of identifying I quote, "some plasmacytoid lymphocytes see". I am extremly worried and was hoping to talk to someone in this regard. What is this, why and what can I do to get things to normal again?? Please help me I am desparate. Thanks
Thanks, it's a Sherlock world when the usual diagnosis decision trees don't give an answer :) It's looking like the worms caused a cascade.
Here's a nice narrated animation of mucosal immunity, worth watching a few times: http://www.youtube.com/watch?v=gnZEge78_78
There is also a DIY at home test (that then gets mailed in) for leaky gut. It uses unabsorbable sugars, mannitol and lactulose. If they show up in urine, that means you absorbed them when you shouldn't.
Speaking of 'unabsorbable', there are also relatively unabsorbed ABXs like rifaximin, which are meant to treat bacteria in the gut only. E.g., SIBO. Then again, if there is a yeast problem instead, an ABX can make that worse.
But you don't have general tiredness, malaise? Like a poisoned feeling?
Here's a nice narrated animation of mucosal immunity, worth watching a few times: http://www.youtube.com/watch?v=gnZEge78_78
There is also a DIY at home test (that then gets mailed in) for leaky gut. It uses unabsorbable sugars, mannitol and lactulose. If they show up in urine, that means you absorbed them when you shouldn't.
Speaking of 'unabsorbable', there are also relatively unabsorbed ABXs like rifaximin, which are meant to treat bacteria in the gut only. E.g., SIBO. Then again, if there is a yeast problem instead, an ABX can make that worse.
But you don't have general tiredness, malaise? Like a poisoned feeling?
Ken, once again--thanks for the troubleshooting. I appreciate that you approach this like a Holmesian puzzle! Also, kudos on the Swift reference.
As to the pinworms, they occurred before any of the other GI symptoms. The worms were only symptomatic in that they caused itching. They predated the other GI symptoms by a month or so.
The nurse didn't remark on the thickness of the blood--and truthfully, I've never really had that problem before; every time I've donated, I've been told I've got a good flow. She just may have picked a bad spot to draw from.
You've given me a lot to consider. Thank you again.
As to the pinworms, they occurred before any of the other GI symptoms. The worms were only symptomatic in that they caused itching. They predated the other GI symptoms by a month or so.
The nurse didn't remark on the thickness of the blood--and truthfully, I've never really had that problem before; every time I've donated, I've been told I've got a good flow. She just may have picked a bad spot to draw from.
You've given me a lot to consider. Thank you again.
Thanks for saying those nice things, I appreciate it.
A normal LDH might alleviate some of the fears of lymphoma.
Yes, SIBO is possible. It's one of those currently trendy topics, but it still can have value despite being trendy. My guess is that your problems arise from some gut infection, which might be complicated with secondary infections.
Two questions exist:
1) Which infection came first? AFAIK, lots of people get helminths but not even the majority get clinical manifestation.
2) So why you? Maybe there was some previous infection which opened the door. Infectious agents have a way of trying to neutralize the host immune system, so that also paves the way for secondaries (famously like a bacterial after a viral pneumonia). Or maybe you have weakened immunity for some reason. Or maybe you just unluckily encountered some especially virulent agent which would have overcome anybody.
Yes, chronic viruses are always possible, though for some reason some docs say that it isn't possible. Chronic EBV is a classic example. Chronic pinworms or periodic reinfection by pinworms seem also possible.
So now, you must correlate the timeframe of when symptoms arose and/or intensified with when the exposure to pinworms occurred.
Also, the Albenza could have caused bad side effects, especially hematological effects. (Aplastic aneemia and marrow suppression are listed.)
Have you read about zinc use to restore gut absorptive ability? E.g:
http://www.druglib.com/trial/08/NCT01440608.html
Maybe the RBC problem did arise from inability to absorb iron, because of the helminth causing enterocyte damage? Less likely: you are allergic to that drug; but you probably would have noticed sharp effects early during treatment.
"difficulty getting a full vial for the CBC". Do you mean the blood was very thick? That's interesting, but I can't quite put my finger on why... especially as your ESR is okay.
Btw, there should be markers for various infections. E.g., of the different types of antibodies, IgE is the one mainly fighting helminths, like numerous Lilliputians fighting relatively-giant Gullivers.
The cells that mainly work with IgE are mainly Eosinophils. They might be high normal on your CBC? But guess what, IgE is also heavily involved in allergies. So maybe your basophils are also high normal. IgE also works to sensitize mast cells, which are super plentiful in the gut lining and are involved in allergic reaction - as in being allergic or hypersensitive to all kinds of food intake.
For viral infections, lymphocytes tend to get high. For bacteria and fungus, neutrophils. But a lot of exceptions exist.
So it all gets super complicated, but that should take your mind off of cancer :)
A normal LDH might alleviate some of the fears of lymphoma.
Yes, SIBO is possible. It's one of those currently trendy topics, but it still can have value despite being trendy. My guess is that your problems arise from some gut infection, which might be complicated with secondary infections.
Two questions exist:
1) Which infection came first? AFAIK, lots of people get helminths but not even the majority get clinical manifestation.
2) So why you? Maybe there was some previous infection which opened the door. Infectious agents have a way of trying to neutralize the host immune system, so that also paves the way for secondaries (famously like a bacterial after a viral pneumonia). Or maybe you have weakened immunity for some reason. Or maybe you just unluckily encountered some especially virulent agent which would have overcome anybody.
Yes, chronic viruses are always possible, though for some reason some docs say that it isn't possible. Chronic EBV is a classic example. Chronic pinworms or periodic reinfection by pinworms seem also possible.
So now, you must correlate the timeframe of when symptoms arose and/or intensified with when the exposure to pinworms occurred.
Also, the Albenza could have caused bad side effects, especially hematological effects. (Aplastic aneemia and marrow suppression are listed.)
Have you read about zinc use to restore gut absorptive ability? E.g:
http://www.druglib.com/trial/08/NCT01440608.html
Maybe the RBC problem did arise from inability to absorb iron, because of the helminth causing enterocyte damage? Less likely: you are allergic to that drug; but you probably would have noticed sharp effects early during treatment.
"difficulty getting a full vial for the CBC". Do you mean the blood was very thick? That's interesting, but I can't quite put my finger on why... especially as your ESR is okay.
Btw, there should be markers for various infections. E.g., of the different types of antibodies, IgE is the one mainly fighting helminths, like numerous Lilliputians fighting relatively-giant Gullivers.
The cells that mainly work with IgE are mainly Eosinophils. They might be high normal on your CBC? But guess what, IgE is also heavily involved in allergies. So maybe your basophils are also high normal. IgE also works to sensitize mast cells, which are super plentiful in the gut lining and are involved in allergic reaction - as in being allergic or hypersensitive to all kinds of food intake.
For viral infections, lymphocytes tend to get high. For bacteria and fungus, neutrophils. But a lot of exceptions exist.
So it all gets super complicated, but that should take your mind off of cancer :)
Ken, I can't thank you enough for all of your suggestions.
The draw was indeed done using venipuncture, and I see on the report that it says "verified by microscopic examination" in the hematology comments section. As to why this was done, I am not sure. The lab impression by the requesting physician was reported as "all normal."
I have occasional shortness of breath, but not often.
My spleen does not feel tender, and it was just imaged by abdominal ultrasound and found to be unremarkable. I am currently waiting the results from a stool culture, but there is no visible blood or characteristic "black tarry" appearance.
Interesting you mention the parasite. In late June/July I did have pinworms, for which I took two doses of Albenza. I haven't had symptoms of them since then, I suppose.
I have not had an LDH test done, but perhaps will request one?
Another question concerning viral infections -- is it possible that such intestinal infections can thrive for weeks at a time? Further, I've read of conditions like SIBO--is this also a possibility? I realize I may be grasping at straws--but I'm desperately trying to direct myself away from ruminating thoughts of cancer.
I will also add that the technician collecting the sample seemed to be having difficulty getting a full vial for the CBC. The other nurse noted, "that should still be enough for them to be a CBC. I don't think we'll have to do it again." I've read that this can also be a cause of burr cells.
The draw was indeed done using venipuncture, and I see on the report that it says "verified by microscopic examination" in the hematology comments section. As to why this was done, I am not sure. The lab impression by the requesting physician was reported as "all normal."
I have occasional shortness of breath, but not often.
My spleen does not feel tender, and it was just imaged by abdominal ultrasound and found to be unremarkable. I am currently waiting the results from a stool culture, but there is no visible blood or characteristic "black tarry" appearance.
Interesting you mention the parasite. In late June/July I did have pinworms, for which I took two doses of Albenza. I haven't had symptoms of them since then, I suppose.
I have not had an LDH test done, but perhaps will request one?
Another question concerning viral infections -- is it possible that such intestinal infections can thrive for weeks at a time? Further, I've read of conditions like SIBO--is this also a possibility? I realize I may be grasping at straws--but I'm desperately trying to direct myself away from ruminating thoughts of cancer.
I will also add that the technician collecting the sample seemed to be having difficulty getting a full vial for the CBC. The other nurse noted, "that should still be enough for them to be a CBC. I don't think we'll have to do it again." I've read that this can also be a cause of burr cells.
Good morning, Yes, I think this is important. It might not be that significant if you had no symptoms, but you do have symptoms so this is a clue.
This finding seems to come from a smear (using a blood draw via a needle, and then microscopic examination), not just an ordinary CBC which is done with a finger stick. The question arises on why this more elaborate investigation was done.
These are apparently echinocytes aka acanthocytes, being star star shaped.
For abnormally shaped RBCs, we'd possibly first look at nutritional malabsorption - because of your gut symptoms. Therefore possibly iron deficiency. Do you have recent or chronic SOB?
But... could this result have come from the sudden onset and only recent condition? I'm guessing not (RBCs have a lifespan of a few months), so this poikilocytosis would have predated the past week's development.
You might as well press on your spleen to check for tenderness. Have you been lab checked for blood in stool? Or seen any red or black color?
Any possibility you got a parasite, from food or swimming or something like that? Any travel?
Here's a DDx: http://en.diagnosispro.com/differential_diagnosis-for/burr-cells-on-smear-lab/30684-154.html
Just offhand, here is what is looking most likely at this point, CMV (or presumably other similar viruses) can be in the intestine
http://www.mayoclinic.com/health/cmv/DS00938/DSECTION=complications
And/or maybe you had some chronic infection which weakened gut mucosal immunity and led the way for a second, sudden-onset infection -- as in when a viral pneumonia leads to a (more serious) bacterial pneumonia.
Btw, did you have an LDH test done?
This finding seems to come from a smear (using a blood draw via a needle, and then microscopic examination), not just an ordinary CBC which is done with a finger stick. The question arises on why this more elaborate investigation was done.
These are apparently echinocytes aka acanthocytes, being star star shaped.
For abnormally shaped RBCs, we'd possibly first look at nutritional malabsorption - because of your gut symptoms. Therefore possibly iron deficiency. Do you have recent or chronic SOB?
But... could this result have come from the sudden onset and only recent condition? I'm guessing not (RBCs have a lifespan of a few months), so this poikilocytosis would have predated the past week's development.
You might as well press on your spleen to check for tenderness. Have you been lab checked for blood in stool? Or seen any red or black color?
Any possibility you got a parasite, from food or swimming or something like that? Any travel?
Here's a DDx: http://en.diagnosispro.com/differential_diagnosis-for/burr-cells-on-smear-lab/30684-154.html
Just offhand, here is what is looking most likely at this point, CMV (or presumably other similar viruses) can be in the intestine
http://www.mayoclinic.com/health/cmv/DS00938/DSECTION=complications
And/or maybe you had some chronic infection which weakened gut mucosal immunity and led the way for a second, sudden-onset infection -- as in when a viral pneumonia leads to a (more serious) bacterial pneumonia.
Btw, did you have an LDH test done?
Fair enough. Thanks again for your help. I did happen to notice one more thing on my CBC report. Under RBC, the technician noted "burr cells present."
In all my searching, I haven't been able to find a clear answer to what burr cells are, and what may be their pathological cause--or, if none--if they are just an occasional incidental finding. You seem quite knowledgeable. Any ideas?
In all my searching, I haven't been able to find a clear answer to what burr cells are, and what may be their pathological cause--or, if none--if they are just an occasional incidental finding. You seem quite knowledgeable. Any ideas?
Well, there is something wrong and it's not all in your mind - but I wouldn't divert into thinking about about MALT or anything similar at this point.
For some reason, CMV keeps coming up in articles. If not that, then perhaps some virus that behaves similarly.
Among the many trendy things that come along that don't pan out (like the current fixation with vitamin D or gluten), there are still some that seem to ring true, and gut microbe composition seems like the real thing to me. Or maybe an infection is causing degradation of the 'tight junctions' and making you appear allergic to all proteins in food. NSAIDs make it worse, as do other things.
No blood in stool is a good sign, re cancer.
Being your own detective might be your best bet. Also considering Hx (antibiotics) and Fx (autoimmunity etc) . Maybe trying glutamine for healing. Good luck. Please post back with any results that you experience, or any further questions.
For some reason, CMV keeps coming up in articles. If not that, then perhaps some virus that behaves similarly.
Among the many trendy things that come along that don't pan out (like the current fixation with vitamin D or gluten), there are still some that seem to ring true, and gut microbe composition seems like the real thing to me. Or maybe an infection is causing degradation of the 'tight junctions' and making you appear allergic to all proteins in food. NSAIDs make it worse, as do other things.
No blood in stool is a good sign, re cancer.
Being your own detective might be your best bet. Also considering Hx (antibiotics) and Fx (autoimmunity etc) . Maybe trying glutamine for healing. Good luck. Please post back with any results that you experience, or any further questions.
Hi Ken,
Thanks for your reply. No--no bone pain or increased rate of infection. And yes, of course MM and other neoplastic causes were on my mind.
I to my knowledge a snear was not ordered. Just a normal CBC with (automated?) diff.
If I understand you correctly then, without more, these could be incidental common findings that are no cause for concern?
Thanks again.
Thanks for your reply. No--no bone pain or increased rate of infection. And yes, of course MM and other neoplastic causes were on my mind.
I to my knowledge a snear was not ordered. Just a normal CBC with (automated?) diff.
If I understand you correctly then, without more, these could be incidental common findings that are no cause for concern?
Thanks again.
A plasmacytoid lymphocyte looks like a cross between a lymphocyte and a plasma cell.
Lymphocytes just wait around on duty until they are called upon to react to an infection. Under a microscope they look like a cell that's all nucleus and not much else. Imagine an egg that is all yolk. But once activated, so to speak, they get larger and now visually have more to them than just the nucleus, because they are geared up to do their job. The subtype of lymphocytes called B-cells eventually become 'plasma cells', which produce and emit antibodies to fight infection.
Do you happen to have any bone pain? I suppose you would have mentioned that, though. Are you very susceptible to infections lately? I mention these just in case you have researched and came up with MM.
But still, since you are very aware of the importance of considering rates of incidence, I'd look at a viral infection (like cytomegalovirus) as causing the appearance of plasmacytoid lymphocytes rather than a neoplasm. Yours were likely just observed partway through their transformation and shouldn't be thought of as a sign of anything worse. That's especially true because they saw only "few". Was a smear done?
Lymphocytes just wait around on duty until they are called upon to react to an infection. Under a microscope they look like a cell that's all nucleus and not much else. Imagine an egg that is all yolk. But once activated, so to speak, they get larger and now visually have more to them than just the nucleus, because they are geared up to do their job. The subtype of lymphocytes called B-cells eventually become 'plasma cells', which produce and emit antibodies to fight infection.
Do you happen to have any bone pain? I suppose you would have mentioned that, though. Are you very susceptible to infections lately? I mention these just in case you have researched and came up with MM.
But still, since you are very aware of the importance of considering rates of incidence, I'd look at a viral infection (like cytomegalovirus) as causing the appearance of plasmacytoid lymphocytes rather than a neoplasm. Yours were likely just observed partway through their transformation and shouldn't be thought of as a sign of anything worse. That's especially true because they saw only "few". Was a smear done?
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