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Bloodwork confusion

Let me start off by saying this pertains to my husband.
He’s 33 years old, ordinarily healthy man. Never really goes to the dr until Oct 2020.
Oct 2020- late evening- sudden chest pain, jaw pain, shoulder pain. ER, no heart attack, said anxiety was sent home. The next couple days were a blur, he was sick, vomiting, fever, diarrhea, headache, chills, etc. better a week later.
Now, this is when it started to get weird. Every couple weeks, similar things would happen, he would start feeling off having rapid heart rate and zoned out. Would go to. ER always said he was fine.
He has always had chronic diarrhea for as long as I’ve known him. But since Oct it’s been green. Idk if that’s even relevant. His first WBC -17 (it went up and down for. 13-17 from oct to now.)
I’ll post blood work as follows
1/11/2021 - this was done I think the er
WBC 13.2K/UL
RBC 5.28
Hemagolobin16.6
Hemacrit 47.6%
MCV 90.1
MCH 31.4
MCHC 34.9
RDW 12.8%
Platelet 253
Absolute Neut 7
Absolute Lymph 4.9
Absolute Mono .9
Absolute Eso .3
Absolute Baso .2

The next day
1/12/2021 - follow up at dr bloodwork
WBC 17
RBC 5.3
HGB 16.2
HCT 47.5%
MCV 90.8
MCH 31
MCHC 34.1
RDW 12.4%
PLT 290
MPV 9.7
Neut # 10.6
Lymph # 4.8
Mono # 1 10
ESO #. 42
BASO # .11

He’s seeing a hematologist, but have to wait until early March for bloodwork.
No swollen nodes, no easy bruising, no rashes, no fevers, no weakness, no night sweats, not overly fatigued, no weight loss.

Headaches a few days a week, stomach pain/cramping, green stool, gassy, heartburn, fluttering heart rate/ fast heart rate, also seeing a cardiologist. Slight regurgitation in mitral.

Was taking protonix, but he swears that’s what was causing him to feel off. Surprisingly he has been better since stopping it.
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Avatar universal
Just wanted to add, that he went to his cardiologist today and his echo and stress test came back great.
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Hi, I don't see any reason to suspect a blood cancer.

The green? Probably from green bile, and because of the diarrhea the intestinal contents are moving along too swiftly so that the bile isn't reabsorbed as it normally would be.

Why the chronic diarrhea? The 1st thing that comes to mind is C Difficile, which you might have heard of. That's a bacterial infection that's very hard to get rid of.

How could the Protonix interact? It suppresses the stomach acid that helps to control bacteria. If it was prescribed to lessen the GI symptoms, it might actually make the diarrhea worse.

When the WBC is high, we want to know which component of the WBC is causing that. In this case, it's the neutrophils. The neutrophils are the immune-system blood cells most involved in fighting a bacterial infection.

Severe inflammation of the small intestine can cause the symptoms which seemed to be a heart attack. A toxin from C Difficile can cause severe inflammation of the small intestine.

There is a stool test for C Diff. If that comes out negative, then maybe it's some other infection that he was exposed to.


The odd thing here is that he's been referred to a hematologist. What was the reason for that? Episodic elevation of neutrophils from what appears to be an infection doesn't seem reason enough to see a hema.  



https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-clostridium-difficile-associated-diarrhea-can-be-associated-stomach
Helpful - 0
1081992 tn?1389903637
COMMUNITY LEADER
Did he take a lot of antibiotics before the onset of the chronic diarrhea?
Helpful - 0
1 Comments
He’s dealt with chronic diarrhea for as long as I’ve known him and that’s been 16 years. The only antibiotics he was given was a Z-PAC back in early November bc our primary suspected mild pneumonia (which was odd) bc he had no symptoms.
I think our primary was nervous because of his lymphocyte number and his wbc being 17. I assume they suspected an inflammatory issue, but all the inflammation bloodwork came back fine. I can get those number when my husband is able to sign into his portal. He did see the hematologist early Feb who did not do bloodwork, but instead told him to continue his normal routine and come back early March and she will run tests then (CBC- differential)
1081992 tn?1389903637
COMMUNITY LEADER
Antibiotics often pave the way for C-Diff. You can ask him about the time before he knew you.

"all the inflammation bloodwork came back fine"
If they are high, that is significant. If they are normal, that doesn't necessarily rule out things.

The hema will likely think like this: I'm not alarmed about a cancer, but something odd is going on so I have to keep an eye on things with regular CBCs.

If your husband is alarmed, he can ask for a "blood smear" which uses a microscope to look for certain cells found in lymphocytic leukemias.

The episodes of rising neutrophils (plus the very long term chronic diarrhea) tends to point away from a lymphocytic leukemia, because that says there is something different going on.

Btw, what is the range for absolute lymphocytes on his CBCs? They can be from 4.0 to maybe 4.8 or so, and varies by lab.
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1 Comments
Our lab ranges lymphocytes fro 1.0-2.9
1081992 tn?1389903637
COMMUNITY LEADER
"our primary suspected mild pneumonia (which was odd) bc he had no symptoms"
The neutrophilia is a sign of possible bacterial pneumonia, if there isn't some obvious (to that doc) other explanation. Maybe that was the doc's thinking.

How did the diarrhea respond to the antibiotic?
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1 Comments
He still had diarrhea, before and after antibiotics. He has a hard time eating much of any type of food. There are very few things he can eat without running directly to the bathroom because he cannot hold it.

The doctor did do an X-ray and said she saw what she “thought” was a touch of pneumonia, so that’s when she treated with a Z Pack.
1081992 tn?1389903637
COMMUNITY LEADER
Ok, 2.9 is a low max for #lymph. So his 4.8-4.8 is more than just a bit high.

However, with the background of his neuts going so high, I'd still tend to *not* think of the lymphs in isolation --- but instead as being part of some overall non-cancer inflammation which is possibly infection related.

Since the Abx had no effect, that tends somewhat away from a stomach bacteria. But then again C Diff isn't easily controlled by Abx.

"He has a hard time eating much of any type of food..."
Maybe then there are some food sensitivities. But I wouldn't trust the typical skin-prick tests (that allergists do) to rule out food sensitivities.  

I invite you to take a look at Eosinophilic Disorders, not because he has that but as an example of how some people can have a very bad reaction to many, many different foods. It's caused by immune cells.

But then:
"There are very few things he can eat without running directly to the bathroom because he cannot hold it."
If you mean diarrhea, then that's a clue to something because usually with food sensitivities it's more of immediate vomiting/nausea. But provoking immediate diarrhea? I'm not sure why that would happen if the body wants to immmediately get rid of something it sees as harmful.

He doesn't have food get stuck in the esophagus, right?

I'd keep a food diary, to try and assist the diagnosis. Let's say that it's non-fat foods that are okay, or maybe it's cold foods. Or it's histamine containing foods that are bad. Or all dairy, nuts, and eggs are bad. Or white rice is okay. How about just pressure in the stomach, even from water?

Whatever patterns you can detect. Good luck.


'x-ray... what she “thought” was a touch of pneumonia, so that’s when she treated with a Z Pack'
okay, that explains that quite well


Btw, with the long term GI problems, he might have also developed secondary problems from malnutrition of some essential nutrients.
Helpful - 0
1 Comments
His lymph’s being so high is what freaks me out so badly:(  when I researched lymph # they were all different. Ours are just low for some reason.
1081992 tn?1389903637
COMMUNITY LEADER
As a comparison, in lymphocytic leukemias the numbers can go far higher. If I recall correctly, in Chronic Lymphocytic Leukemia it's 5,000 and above.
Helpful - 0
3 Comments
I do recall, that the max lymph # for the hospital was 3.9 and his number was 4.9
The next day the max lymph # for our dr office lab is 2.9 and his was 4.8.
Let me correct myself: going from memory, there were people here with CLL who said their #lymph was 100 or higher. I just took a quick websearch to see what the typical numbers were for CLL, but it seems almost impossible to find quickly. If I dig it up at some future time, I'll post that here. (...and CLL is not the only one.)

Yes, although it's well known that ranges can vary from lab to lab, it also seems very odd that the max #lymph varies so greatly. I've seen 4.0 and 4.8 and now 2.9. Still, we must always, of course, go by the range specified in any specific lab report.
Thank you, I appreciate this! His appointment is soon, so we will have answers hopefully within the next couple of weeks. I’ll come back and update when we know.
1081992 tn?1389903637
COMMUNITY LEADER
Yes, please post back with an update.

Good luck to you and him. I think you'll be relieved after the visit.
Helpful - 0
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