Q. How to identify the reason behind low TLC and WBC levels?

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Nov 14, 2020

Hello doctor,

My sister in law's TLC are going down continuously from 16-10 and WBC count from 8500 to 2330. She was admitted to the hospital for a kidney issue.

What tests should be done to know the exact cause of WBC going down?

WBC count are continuously decreasing after post-partum sepsis and renal dysfunction treatment. Four units of PRBC, two units platelet, and one unit plasma transfused during treatment. She is on tablet Folvite and tablet Sedron.



Welcome to

Sorry to hear about the ill-health of your sister in law.

In the attached reports (attachment removed to protect patient identity), total count, and absolute neutrophils are low suggestive of bone marrow suppression.

You have mentioned in the history that there was sepsis in the post-partum period. So infection, especially severe infection, is one of the causes of bone marrow suppression. Her low count might be due to that reason mainly. So blood culture can be done to check for the presence of infection.

She needs to be treated for infection, and other supportive treatment should be given. If still no improvement, then bone marrow biopsy can be done.

As of now, the low count seems to be due to infection-induced bone marrow suppression. Anemia i.e., low hemoglobin, could be due to kidney disease or bone marrow suppression.

Kidney secrets EPO (erythropoietin) hormone which stimulate red blood cells production. So kidney disease that causes low EPO might be the reason for anemia.

I hope this helps.

Thank you doctor,

In the peripheral smear report, there is normocytic anemia with mild hemolytic component. What could this be?



Welcome back to

I can understand your concern. Following is my opinion on your asked question.

In the attached peripheral smear report, normocytic normochromic anemia is seen, which means red blood cell size and hemoglobin content are not disturbed.

Normocytic normochromic anemia is usually seen in infections and kidney disease. So, your anemia is due to kidney disease and infective component.

Polychromatic red blood cells are also seen, which suggests hemolysis means the destruction of red blood cells. Mild hemolysis is seen in infection. So hemolysis components, especially polychromatic red blood cells, are seen due to infection itself. It is good that there are no abnormal cells in the peripheral smear.

I hope this helps.

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