What can cause high WBC and low hemoglobin levels in my wife?

Question

Hi doctor,

My wife's iron and ferritin were low, so the doctor ordered a CBC. CBC showed low WBC, high monocytes, and high RBC, which is what scared us.

She has schistocytes and elliptocytes, among other RBC morphologies. We read about it and are very worried. She had a C-section three years back. Her iron is 13 ug/dL, iron binding is 484 ug/dL, iron saturation is 3 %, and ferritin is 3 ng/mL. I have attached her CBC report. Are her reports indicative of something serious?

She also has pain between her legs and in the pelvic area. She has vitamin D and vitamin B12 deficiencies. She also had iron-deficiency anaemia in the past, for which she took Ferrous Sulfate. She is currently taking vitamin D and Thyrax medicines.

Please guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your wife's reports (attachment removed to protect patient identity). The report shows schistocytes, which are fragmented red blood cells (RBCs) commonly seen in hemolytic anemia. To rule out hemolysis, serum LDH (lactate dehydrogenase), reticulocyte count, and serum bilirubin levels should be tested.

If hemoglobinopathy is suspected, high-performance liquid chromatography (HPLC) can be performed, as there is a history of iron-deficiency anemia (IDA), which decreases the iron level and increases the total iron-binding capacity (TIBC). Therefore, treatment for IDA should be initiated with iron tablets, such as ferrous sulfate, or iron injections.

Her monocyte count is slightly elevated, but the absolute monocyte count is more important, which is within the normal limits. Total WBC count is low, which can be due to any drug, infections like tuberculosis, typhoid, parvovirus B19, temporary infection, EBV (Epstein-Barr) virus infection, etc.

Hence, a clinical examination and correlation are necessary. But in the smear, no abnormal cells are seen, so there is nothing alarmingly wrong. Continue treatment for iron-deficiency anemia. Repeat peripheral smear after ten to twenty days and follow up.

I hope that this answers your query.

Please follow up if you have any further questions.

Thank you.