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Q. What can cause low WBC count?

Answered by
Dr. Prakash H Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 10, 2015 and last reviewed on: Oct 09, 2018

Hi doctor,

My father-in-law is 58 years old. He had a stroke a year back and has been diagnosed with non-critical CAD. Within a period of two months, his WBC count has reduced from a range of 7.5 to 2.8. But, there is no sign of infection. The overall count of ANC is more than 1000 and platelets are 140. We consulted a doctor and he has advised us to take few multivitamins and keep a weekly check on the count. How should we proceed further? Please guide.

Dr. Prakash H Muddegowda

Geriatrics Hematology Pathology


Welcome to Based on your query, my findings are as follows.

  • Your dad is suffering with macrocytic anemia along with leukopenia (low level WBC) and pancytopenia (deficiency of RBC, WBC and platelet).
  • There is only a slight decrease in the number of platelets, so you need not worry.
  •  Megaloblastic anemia can occur secondarily due to vitamin B12 and folic acid deficiency.
  • It is advisable to take multivitamins that is vitamin B12 and folic acid supplements. Improvement in counts will be gradual and may take up to two months.
  • The reticulocyte count if increased within a period of 15 days can yield good outcome. If there is no rise in the reticulocyte count, then vitamin B12 and folic acid serum assay will be necessary to rule out any malabsorption.
  • Erythrocyte sedimentation rate (ESR) is normal and there is no abnormalities found in any of the cell lineages.

The Probable causes:

Vitamin B12 and folic acid deficiency.

Investigations to be done:

1. Reticulocyte count. It has to get repeated after 15 days to check if there is any rise in number.
2. Vitamin B12 and folic acid assay.

Probable diagnosis:

Megaloblastic anemia.

Preventive measures:

Improve your nutrition by having eggs, chicken, red meat, pulses and green leafy vegetables.

Regarding follow up:

Revert back with the investigation reports to a hematologist online.--->

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Thank you doctor,

His vitamin B12 and folic acid tests are done but there was nothing deficient. I have attached the previous reports for your information. We are very much worried as this seems to be serious. Our cardiologist has advised us to keep a check and see if there is any improvement within a month and get the blood test done on a weekly interval. Please suggest us what can we expect from the outcome since we are very concerned.

Dr. Prakash H Muddegowda

Geriatrics Hematology Pathology


Welcome back to

  • In your dad's case, cause is not related to nutrition. Other causes at the level of bone marrow need to be evaluated.
  • Please answer few questions for detailed information. Did he undergo any bone marrow biopsy recently?
  • Is there any rise in the reticulocyte count? As Increase in this count will help in good functioning of the bone marrow.
  • Since few drugs can suppress the bone marrow, have you been taking any new medications for the past one year?
  • Do kindly discuss with your doctor regarding the above tests and find a way to get to the cause. Till the main cause is identified take the drugs prescribed earlier.

Revert back with the detailed reports to a hematologist online -->

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