HomeAnswersInternal Medicinehigh monocyteAfter vomiting blood, reports show increased monocytes, why?

After an episode of vomiting blood, my blood report indicates an increased monocyte count. Why?

Share

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At September 9, 2022
Reviewed AtOctober 16, 2023

Patient's Query

Hello doctor,

I have a history of lupus and fibromyalgia. I went to the emergency room due to vomiting blood. Please interpret the blood work.

Thank you.

Hello,

Welcome to icliniq.com.

I have read your attached file (attachment removed to protect the privacy of the patient) and will try my best to guide you in your query. Please ask questions related to it.

Patient's Query

Hello doctor,

Why are monocytes high? Why are platelets high? Why are other values high or low? In general, what does all this mean? Will my blood work all go back to normal? Is it related to lupus? I was told I have H.pylori, but I do not see it there. What would have caused the ulcer?

Hello,

Welcome back to icliniq.com.

Let me go through the reports again and reply to your questions.

In the reports, a gastroscopy was planned, but I do not see the reports of the procedure. Can you attach the report of a gastroscopy?

Your monocyte count is 0.97% which is just above the upper limit normal range. There is nothing to worry about with the above count value, and no further workup is needed. Your latest platelet count is 466 per µl, and according to the hospital laboratory, the range of platelet count is between 140 - 400 µl. A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood, and the range slightly varies from laboratory to laboratory. Your platelet count is 466 µl, so if we consider the upper limit normal range, then it is slightly high, and the reason I could deduce from your history is due to hemoconcentration, which occurred due to recurrent vomiting of 3 to 5 episodes per day for four days. Fluid loss in the vomiting causes a dehydration state, which could lead to hemoconcentration and, thus, mild elevation in the count. My point is at this platelet count, there is nothing to worry about, and in fact, it is good that the numbers are adequate enough, which play a vital role in initiating and maintaining a hemostatic plug in case of any bleeding source in the body. It would come back in the normal range as expected with cessation of the present problem. You have asked about the cause of bleeding, and for this, I would need an endoscopy report; however, one reason for hematemesis and melena is present in the medical history as Mallory Weiss tear due to repeated vomiting. Please attach the upper gastrointestinal endoscopy report to guide you efficiently.

Patient's Query

Hello doctor,

Could not the transfusions have increased the platelet count? There is no report as such available, and I have these findings. My platelets were not high when I entered the hospital and were high during my stay. How could it be from the vomiting? What causes an ulcer? Why chloride and venous blood test is done? Why INR, calcium, magnesium, CK, immature granulocytes, and creatinine values are abnormal?

Hello,

Welcome back to icliniq.com.

I have downloaded the attached file (attachment removed to protect the patient's privacy) and will reply to you in some time after reading it carefully.

Patient's Query

Hello doctor,

Why would monocytes, immature granulocytes, and platelets become abnormal in the last week? At the same time, erythrocytes, hematocrit, and hemoglobin appear to be improving.

Hello,

Welcome back to icliniq.com.

The latest electrolyte panel test done two months back reveals normal Sodium, Potassium, Chloride, Carbon dioxide, and Anion gap, which is satisfying and a normal report. An earlier test was done last month, and the chloride level was slightly high, which is now in the normal range. If you try to dissect the earlier chloride level report, then also it is very slightly high with a normal Anion gap; thus does not require further workup about it. Hemoglobin and other complete blood count parameters are improving due to packed red blood cell (PRBC) transfusion, but PRBC transfusion does not cause an increase in platelet count. Now the question is why there is an increase in platelet count within two days and a change in the immature granulocyte and monocyte count. I am trying to explain about monocyte and immature granulocyte. You can also observe there is an increase in Neutrophil, Lymphocyte, and Leukocyte count in the report produced two days back; however, they are in the normal range now. There is an increase in Leukocyte Count from 7.6 to 10.2 billion/ L, which means there is an ongoing production according to the demand of the body in the bone marrow. Immature granulocytes are premature granulocytes that are released from bone marrow during infection and inflammatory conditions. In the process of new WBC (white blood cell) generation, there is a slight increase in Monocyte and Immature granulocyte (which is part of the WBC component), and the value is not alarming or worrying at all.

Thank you.

Patient's Query

Hello doctor,

I do not understand why they are all increasing and what would have caused the increase in platelets. When can I expect everything to normalize? As you said, immature granulocytes are premature granulocytes that are released from bone marrow during infection and inflammatory conditions, but I do not have any infection. I do have lupus; however, the results were fine two days prior, so that cannot be an inflammatory condition, right? So what would cause this change? I have pre-operation blood work in about three weeks. Can I expect everything to normalize by then?

Hello,

Welcome back to icliniq.com.

I got your worry. Though the value is above the upper limit range of platelet, monocyte count, and immature granulocyte, they are not worrying factors, and they would normalize in upcoming days too. It is tough to dig into the exact cause which you are asking, but due to upper gastrointestinal bleeding, such variations are observed in blood parameters if tested daily. What is important is variations should be in the range, not at the alarming value. I hope it will get normal in the upcoming 3 weeks. Do you have any upcoming surgery after 3 weeks?

Thank you.

Patient's Query

Hello doctor,

Yes, I have surgery in a few weeks. But the bleeding in the upper gastrointestinal portion has stopped, so why the variations? As you said that though the value is above the upper limit range of platelet, monocyte count, and immature granulocyte, they are not worrying factors, and they will normalize in the upcoming days, but I need them to be normal in a few weeks for my pre-operation blood work, and I do not understand why they increased. It is important to my surgeon that everything is completely normal, not only non-alarming. Also, after the first transfusion, my hemoglobin went up but then dipped again. After that, I had another transfusion, and it continued to get better. Why did it dip? I did not vomit any more blood between the first and the second transfusions.

Hello,

Welcome back to icliniq.com.

What is your treating physician's opinion about such variations? Have you sent the latest laboratory report to your surgeon, asking for his opinion regarding fitness for the scheduled surgery?

Patient's Query

Hello doctor,

No, I have not shared it with my surgeon. My treating physician did not really provide an opinion. I do know that my blood work needs to be normal for the surgery. It is important to my surgeon that everything is completely normal, not only non-alarming. I will not be deemed "fit" with these blood work results. I likely will get my blood work in a month.

Hello,

Welcome back to icliniq.com.

Well, you should ask your treating physician about these variations, as he knows your medical condition more elaborately than I do. How much did it dip? You should ask your surgeon doctor about the fitness for surgery based on the latest laboratory report, and the above count would get normalized before your surgery. In my view, for any surgery, normal hemoglobin is essential with normal WBC (white blood cell) count and adequate platelet with normal LFT (liver function test) and RFT (renal function test). Who has told you you would not be deemed fit for surgery? With the above value, surgery would not be deferred, but hemoglobin should reach the normal range.

Thank you.

Patient's Query

Hello doctor,

I think it dipped from 7.4 g/dL to 6.7 g/dL.

Hello,

Welcome back to icliniq.com.

I reviewed your medical summary again. Two units of PRBC (packed red blood cell) were transfused around 10 days back, and the hemoglobin decreased to 7.4 from 5.8 g/dL. Again repeat hemoglobin on the next day was 6.7 g/dL, and 2 units of PRBC were transfused, and hemoglobin is on an increasing trend afterward. I do not know why the hemoglobin value decreased again. Did you have any episodes of black stool after the first blood transfusion? You asked about the cause of hematemesis and melena, and this is likely due to either an underlying ulcer that was exacerbated by postoperative medications or a Mallory-Weiss tear in the context of multiple episodes of vomiting since last week. This is present in the discharge notes. Upper gastrointestinal endoscopy was done 5 days back, which revealed a clean-based shallow ulcer and Mallory Weiss tear, and now it is healing, which is a positive sign. You asked me why there was an ulcer, and it may be due to stress-induced after surgery and medication. Please do not stress yourself too much and take prescribed medications as instructed. These laboratory values would become normal in a few days, and do not worry much.

I hope I have been able to answer your query.

Thank you.

Patient's Query

Hello doctor,

Thank you.

Hello,

Welcome back to icliniq.com.

Do not bother about minimal variations in the laboratory reports. I wish for your fast healing and early recovery. Which surgery has been scheduled after three weeks?

Please do follow up if you have any queries.

Patient's Query

Hello doctor,

The surgery to remove loose skin post weight loss.

Hello,

Welcome back to icliniq.com.

Okay.

Patient's Query

Hello doctor,

Thank you so much. Will all my blood work be back to normal in a few weeks?

Hello,

Welcome back to icliniq.com.

I expect it to get normal in a few weeks. Just adhere to the medication properly and follow diet instructions for faster recovery. Take PPI (proton pump inhibitor) and Iron supplements on time and other prescribed medication.

Patient's Query

Hello doctor,

They said I do not have H. pylori, but I do not see that in my records. How can I be sure I do not have it? It is not stated anywhere.

Hello,

Welcome back to icliniq.com.

The upper gastrointestinal endoscopy reveals two findings mentioned in the report, which means findings in the different anatomical locations of the stomach, including the proximal stomach, are normal. Helicobacter pylori cause gastric and duodenal ulcers. Most gastric ulcers tend to occur at the junction of the fundus and antrum, along the lesser curvature. More than 95 % of duodenal ulcers are found in the first part of the duodenum. There are no findings in these anatomical locations, which I mentioned above, and also, ulcer due to H.pylori has a different endoscopic appearance. That is why your treating physician told you that you do not have H. pylori.

Patient's Query

Hello doctor,

Okay, so they know I do not have it, then?

Hello,

Welcome back to icliniq.com.

Yes, they know you do not have Helicobacter pylori (H. pylori) findings in the Endoscopy.

Patient's Query

Hello doctor,

Thank you for your response.

Did they do any blood tests regarding the infection? I remember that shortly after I was admitted, they mentioned I was being tested for it but that the results would take a few days. Where in my chart is this blood test?

Thank you.

Hello,

Welcome back to icliniq.com.

Which blood test are you trying to ask for? If you have done any recent tests, kindly attach the reports for further suggestions.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Ask your health query to a doctor online

Internal Medicine

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy