6 replies to this topic

[Happycat]

Hi,

I have to come to my peeps for this one, so I don't drive myself crazy with worry.   It's not leukemia-related, but I figure we've all read so much stuff on hematology, maybe someone has run across this and can point me in the right direction.  I mentioned a few times that my dd has just been dx'd with eosinophilic esophagitis, which is essentially an allergy reaction where the eosinophils start crowding into the tissues of the esophagus.

So, having learned to get copies of test reports, I requested they send me the blood tests they did on her back in March.  I wanted to see if it showed any eosinophilia in the peripheral blood (it does not).  However, I note that her total WBC is low (3.06), absolute neutrophil count is low (1.06) and the report states there is a left shift "present".  Basophils and eosinophils are normal.  Lymphocytes, monocytes, hemoglobin, hematocrit, and RBC is high.

So what do you make of a low WBC when a patient does not have leukemia?  I know a high WBC might indicate infection, but what does a low WBC mean???

TIA,

Traci

[Sneezy12]

It may represent a Viral infection. Medications may also cause Neutropenia. I would repeat it.

Also, the tests on her back were Prick Skin tests, not blood tests. She may have also had RAST(blood) tests for allergy.  Eosinophilia in the peripheral blood may not be correlated with Eosinophilic Esophagitis. Frank

[Happycat]

Thanks, Frank. Em has had all types of allergy tests, only RAST showed positive, but I think she's headed for a retest.

So low WBC can be a viral response?  I thought that led to high WBC?  Or do the WBCs have to commit suicide to take out the bad guys, leading to an eventual low WBC? 

Hmm, well if that's the case, it might make sense. She was sick a few weeks before the blood draw.  So if her WBC was in a recovery stage, the left shift is likely normal.

I wasn't expecting to have questions with the rest of her CBC. I just wanted to look at the eosinophils. Go figure.

Traci

[Sneezy12]

Traci,

If a properly done Prick Skin Test or a RAST test is negative, there is a 95% chance that the patient is NOT allergic to the antigen. If however, either of these tests is SIGNIFICANTLY positive (and there are parameters), one must correlate the positive test with the clinical history. This is especially important with positive FOOD tests, where there may be false positives. These "positive" food tests must be confirmed with Placebo-Controled Food Challenge Testing. Of course, Eosinophilic Esophagitis is not uncommonly associated with food allergy.

[Trey]

A left shift (increase in immature WBCs in the blood) normally occurs in response to inflammation or an infection.   If a re-test shows they have decreased, then it was likely temporary.  If not, it is likely related to the Eosinophilic Esophagitus issue, since it is a type of inflammation. 

The low neutrophils with high lymphocytes often shows that the body changed its production priorities to fight a virus.  So it produces more lymphocytes instead of neutrophils since more lymphocytes are needed to fight a virus.  For infections, the reverse occurs.  But her counts may simply show a residual effect of her previous illness.

[Happycat]

Frank,

She had her allergy tests done by her regular allergist, but with this dx, she will now see the allergist who is in the EE program. I think the skin prick tests may need a repeat, becuase the protocols look a little different to me, most importantly how long to stop Zyrtec prior to testing. I'm afraid her allergist didn't top the Zyrtec early enough to see a good response. The histamine control popped up, but almost nothing on the food, just a little oat.  Considering how she behaves with certain foods, I think she may have a few more allergies.

So I'll see wht the new allergist has to say about the tests next month. I figure he knows how EE works with allergies, and will be better able to run and read the results. Em won't be happy about the retests, though!

Thanks for the info,

Traci

[Happycat]

Trey,

Thanks for the info. So, lymphocytes go after viruses, and neutrophils go after bacteria?  Never realized they were so specific. The information is helpful, since she had a viral infection with fever not too long before the tests, so that squares with high lymphocytes and low neutrophils.

Much appreciated! 

Traci