Q. My WBC counts are falling down. What is the reason?

Answered by
Dr. Elina Angelova Beleva
and medically reviewed by iCliniq medical review team.
Published on Jul 09, 2018 and last reviewed on: Oct 09, 2018

Hi doctor,

I am concerned about my low and falling WBC count recently. I do not have any chronic diseases. My doctor says, it is vitamin B12 deficiency and the doctor has prescribed Vitamin B12 to take 1000 mg per day. My mother had MDS, diagnosed two years back and expired from it. My WBC counts recently in the past three months were 3.23 K/mcL, 3.13 K/mcL, 4.50-11.00 K/mcL, respectively.

#

Hi,

Welcome to icliniq.com.

I can understand your worries. First, it is of utmost importance to have a glass slide reviewed by a hematologist to check for the morphologic abnormalities, that is the dysplastic features of the cells. Not only it depends on the count, but also on the appearance of the cells that give the diagnosis of myelodysplasia. In your case, none of the absolute values of neutrophils, Hb or platelets qualifies for meeting the threshold criterion for MDS (myelodysplastic syndromes) (attachment removed to protect patient identity). These are called prerequisite criteria and they are Hb less than 110 g/L, neutrophils less than 1.5 g/L and for platelets less than 100 g/L. A glass slide review will also cover if any abnormal cells are present. If there are dysplastic features and abnormal cells present then, a further diagnostic workup is definitely needed. In your case, the prerequisite criteria are not met. If a glass slide has not been reviewed, I suggest to do it once.

Secondly, it is important to check for hematinic deficiencies such as vitamin B 12, folic acid, and iron. You have your serum levels of folic acid checked, because you may be deficient, since, the folic acid normally does not have proper stores in the body. Your vitamin B12 is close to the lower limit, which means that there might be a functional deficiency, causing megaloblastic changes in the bone marrow and this may be the reason behind the low neutrophil counts. Consider intake of any medications, that may cause suppression of bone marrow. Non-steroidal anti-inflammatory agents and Paracetamol are the reason behind the low count of neutrophils. I would consider these points before taking diagnostic work up to MDS.

For more information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

Thank you doctor,

My doctor has done a morphology review. I was not able to get the full report but, here is the pathologist comment given below. I think it looks fine. They have not mentioned the abnormalities. Pathologist blood smear consult comment: Leukopenia with occasional reactive appearing lymphocytes, ruled out viral or other infection, drug or alcohol effect, an autoimmune process.

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Hi,

Welcome back to icliniq.com.

Yes, the report says that there are no abnormal cells like blast cell as well as dysplastic features. The report describes a finding regarding the lymphocytes (these are white blood cells which are produced by the immune system and not by the bone marrow) that they are reactive. This means that they have a more abundant appearance which can be present when they are active and trying to produce antibodies. This does not imply an infectious state.

Normally, our body gets in contact with many foreign particles with which they struggle to prevent them from entering into the body. Usually, when this process functions properly, no disease develops. These reactive lymphocytes are the sign that the immune system is competent and active. Sometimes, they indicate an overactive immune system, therefore the pathologist is supposed to check for viral infection or autoimmune state. But, if you have no concomitant complaints, I would suggest that this is just a normal reactivity and I will advise you to go for checking folic acid and iron.

For more information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

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