Q. My CBC report shows a sudden increase in WBC with reduced RBC count. Is there any concern?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Nov 11, 2020

Hello doctor,

I am concerned about my recent CBC results. My monocytes are high at .79, and also my hematocrit and platelets are gradually decreasing. I saw my primary care physician for my elbow, arm pain, and had my annual CBC. Then a few weeks later, I had blood in my urine. My doctor ordered another CBC and showed increased monocytes and no infection on urinalysis. Urine culture is also negative.

A week later, the third CBC showed an increase in WBC from 4.9 to 6.9, and some encouraging levels were labeled low. Also, immature granulocytes are increased to 0.02. I am just making sure that there is not a process starting. I appreciate any information. Please help.



Welcome to icliniq.com.

You should have uploaded the CBC report to document anemia's degree (cluing towards the potential cause of anemia by red cell indices) and thrombocytopenia. However, anemia could be due to the loss of blood in the urine. Contrarily, blood loss in urine might be menstrual. Please upload the results of CBC (complete blood count), RFT (renal function test), ALT (alanine transaminase), ferritin, RBC (red blood cells) folate levels.

Thank you doctor,

I will send you all my CBC reports. I think they look normal, and my concern is about the increase in WBC and lower RBC counts. I have not seen blood in my urine and no bacteria present.

I understand that numbers will fluctuate, and my concern is the big jump in WBC in one week (from 4.9 to 6.9). My monocytes decrease within a week from 14% to 12%, but absolute monocyte increased from .68 to .79 (reference range is 0-.80), and that scares me again with no sickness whatsoever. I am concerned about chronic leukemia or something like that.

I am fairly healthy and never smoked or drank. I had a colon tubular adenoma pre-cancerous polyp of 5mm at 37 years and had normal colonoscopies. All have been clear for 10 years now. I was young, but my grandmother died of colon cancer, so probably a heredity reason.



Welcome back to icliniq.com.

I have seen your CBC reports. (attachment removed to protect patient identity).

Your hemoglobin is normal for your age and gender. No sign of anemia was found. WBC (white blood cells) reference range for a normal individual is 3.9-11. And the clinical range is below or equal to 3.8.

Monocytes are long-living cells, the longest to stay in the blood after lymphocytes. However, any chronic inflammation, including viral, fungal, and bacterial, might increase monocytes.

For leukemia, monocytes should be more than 1.0 without known causes. Moreover, leukemia is not a mere number game of blood cells. It is a whole package and includes markedly low platelets, marked anemia, organ infiltration and damage, bleeding disorders, repeated and resolving infections and fevers, etc. So feel free and enjoy life. As per my knowledge and practice of over 20 years, you are free from leukemia.

Thank you doctor,

I was just worried because the hemoglobin that had gone down from 14.5 to 13.5, and the monocytes increase. And I was not sure if a gradual increase and decrease matters. I appreciate your knowledge and experience and will not worry.



Welcome back to icliniq.com.

However, start taking iron-rich multivitamin pills once daily, 20 minutes before breakfast. It would take care of micronutrient deficiencies.

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