Abnormal Drop in Lymphocyte Levels

[H.concern.123]

Hi everyone,

About a month back, I was experiencing formation of lumps on my calves. My physician, in addition to ordering a Venuous Doppler Scan, also asked me to take a wide range of blood tests including the CBC. My lymphocytes as per that report 18.4 (on the lower end of the general spectrum). My physician at that time shrugged it off and told me not to worry about it.

Fast forward one month to today, and I went for another round of testing today including the CBC. And my lymphocyte levels actually came down to an 11.4. I have been experiencing inflammation on those lumpy areas I originally went to the doctor for last month, and am not sure if they had a part to play in the drop in the lymphocytes (going to see the doc tomorrow for the same).

Since the internet pretty much throws scary diseases when you search for a low lymphocyte count, I wanted to check if there are any other reasons why the count could drop so much in just over a month? One thing that I also noticed were my Iron levels being lower than the normal range in today’s report.

[mkh9]

Hi, I hope you have seen your doctor since this message. Did he explain why you had the drop in the Lymphocytes? Was this count you are talking about part of the complete blood count that has the percent of cells? Those do have reference ranges, but also,  they can vary based on what your neutrophils (white blood cells) are doing. What the laboratory does is read a percentage of cells until they reach 100. Then they get a percent based on how many of each type of cell in 100 cells they see. If the neutrophils (white blood cells, also called "segs" ) are high it can make the other cells appear low since it is a percentage. Let me know if you still have any questions. I can take a look. I need the ranges for your laboratory as well.  Usually, the neutrophils are high when you have some type of infection. This would also make the lymph nodes swell sometimes. Did you have any fever or other symptoms at the time?
    Also, if your iron is low your red blood cells can have "atypical" look to the lab, or your hemoglobin will be low if you are very anemic. Usually, if you are very iron deficient, you will be extremely tired. You can get an iron, ferritin, total iron binding capacity and/or transferrin. But your RDW on the CBC would be high.  Let me know what you find out.
take care,
mkh9

[mkh9]

p.s. did you get the doppler done? What did the doctor say about it?
mkh9

[H.concern.123]

Hi @mkh9, thank you so much for the response. So I talked to my Physician about this and she did not seem to worried about it. Not sure if I was completely convinced by her optimism but am trying to hold onto the explanation.

She basically said that the drop in lymphocyte counts is only a reason for concern if there’s an accompanying decrease in WBC count as well. In my case, the TLC number actually increased by almost 10% from the previous month. I realise now that I should have posted my ranges for a better context. Sharing those figures here now:

TLC (Jan’22) vs. TLC (Feb’22)
6270 vs. 6900
Ref range: 4000 - 11000

Neutrophils (Jan’22) vs. Neutrophils (Feb’22)
66.1 vs 69.9
Ref range: 40-75%

Lymphocytes (Jan’22) vs Lymphocytes (Feb’22)
18.4 vs 11.9 (the one that has me worried)
Ref range: 20-40%

Eosinophils (Jan’22) vs Eosinophils (Feb’22)
9.4 vs 7.0
Ref range: 1-6%

Monocytes (Jan’22) vs Monocytes (Feb’22)
5.6 vs. 10.9
Ref range: 1-10%

Basophils (Jan’22) vs Basophils (Feb’22)
0.5 vs 0.3
Ref range: 0-1%

I haven’t had an infection or fever that I can remember (the last bout of cold I had was in Dec’21) but my doctor did say that she has been seeing a lymphocyte decrease-monocyte increase combination in folks recovering from COVID, and mentioned I could have had an asymptomatic brush with it during the recent Omicron wave. One thing I have been experiencing in the past 1 month which also prompted the consultation was the development of swelling on my legs in the lumpy areas that were scanned in the venuous doppler in Jan’22. My doctor took one look and confirmed it was a combination of Edema (she showed how areas of my calves and ankles were forming pits when pressed) and stasis dermatitis which usually accompanies edema. Told me to manage my BP / stress and reduce weight (I’m obese) to deal with the edema. Wonder if this also had an effect on the differential numbers?

Lastly, while the iron numbers were low, the haemoglobin numbers were normal in both the tests - 15.8 in Jan vs 15.1 in Feb. RDW numbers in the Feb report were towards the higher side of the range but still in the ref range:

RDW - SD: 45.3
Ref range: 39-46

RDW - CV: 13.3
Ref range: 11.6-14.0

[mkh9]

I took a look again and agree that it could have been from a virus. Also, edema can cause similar changes in Lymphocytes. Allergies can change the Eosinophil count as well.  I think it isn't anything to worry about.  But you can recheck maybe in 3 months. But just follow what the doctor says as I think they are correct. The RDW looks good.
mkh9

[H.concern.123]

Thanks @mkh9, planning to do that!