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Q. How to know if the increase in WBC is due to an infection or a neoplasm?

Answered by
Dr. Abdul Aziz Khan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 24, 2021

Hello doctor,

I need some follow-up information about a 77-year-old cousin diagnosed with JAK2 myeloproliferative and myelodysplastic neoplasm two years ago. He is being treated by a hematologist and gets consultation from his family physician. Unfortunately, he had several infections over the past year. I understand that his condition can progress into an acute transformation, although he is hematologically stable. We know that the CRP and white blood cell count are typically elevated when a person has an infection. But we have also been told that the CRP and WBC can be high when a person has an acute transformation. Is there any way in which a physician can reasonably differentiate between an acute transformation and an infection by analyzing blood tests even if the diagnosis cannot be proved?

Thanks.

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#

Hello,

Welcome to icliniq.com.

It is confirmed by relevant history suggestive of infection. Immunophenotyping of peripheral blood or bone marrow is required to rule out acute transformation. So, you should consult a hematologist to make a proper diagnosis.

Regards.

Hello doctor,

Thanks for the reply.

I understand that an acute transformation is life-threatening. Is an overlap myeloproliferative or myelodysplastic neoplasm itself is a life-threatening diagnosis or is it concerning only when the overlap condition reaches a certain point?

Thanks.

#

Hello,

Welcome back to icliniq.com.

Most of the time, they transform into acute leukemia. And the response of the patients to treatment will be poor.

Regards.

Hello doctor,

Thank you again for your response.

He is taking tablet Hydroxyurea 500 mg once daily. However, he does not like the side effects of the medication and is talking about stopping it. I am pretty concerned about this. Is it possible for someone with his condition to very quickly and seriously deteriorate by suddenly stopping the medication?

Thanks.

#

Hello,

Welcome back to icliniq.com.

Hydroxyurea is the least toxic drug used in oncology with minimal side effects. If he stops taking it, WBC (white blood cell) count may go high, or hemoglobin may get low. Transformation to acute leukemia can occur anytime and is difficult to predict.

Regards.


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