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HomeAnswersHematologylow wbc countMy father-in-law's WBC count has declined. Why?

What can cause low WBC count?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 10, 2015
Reviewed AtFebruary 15, 2024

Patient's Query

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 a few multivitamins and keep a weekly check on the count. How should we proceed further? Please guide.

Answered by Dr. Prakash. H. M.


Welcome to icliniq.com.

Based on your query, my findings are as follows.

  1. Your dad is suffering from macrocytic anemia along with leukopenia (low-level WBC) and pancytopenia (deficiency of RBC, WBC, and platelet).
  2. There is only a slight decrease in the number of platelets, so you need not worry.
  3. Megaloblastic anemia can occur secondarily due to vitamin B12 and folic acid deficiency.
  4. It is advisable to take multivitamins that are vitamin B12 and folic acid supplements. Improvement in counts will be gradual and may take up to two months.
  5. The reticulocyte count if increased within a period of 15 days can yield a 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.
  6. The erythrocyte sedimentation rate (ESR) is normal and there are no abnormalities found in any of the cell lineages.

The Probable causes

The probable causes are 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.

Patient's Query

Hi doctor,

Thank you for the reply,

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 at a weekly interval. Please suggest to us what can we expect from the outcome since we are very concerned.

Answered by Dr. Prakash. H. M.


Welcome back to icliniq.com.

In your dad's case, the cause is not related to nutrition. Other causes at the level of bone marrow need to be evaluated.

Please answer a few questions for detailed information.

  1. Did he undergo any bone marrow biopsy recently?
  2. Is there any rise in the reticulocyte count? An increase in this count will help in the good functioning of the bone marrow.
  3. Since few drugs can suppress the bone marrow, have you been taking any new medications for the past 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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Prakash. H. M.
Dr. Prakash. H. M.


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