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Q. What is neutropenia?

Answered by
Dr. Prakash H Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 02, 2016 and last reviewed on: Feb 13, 2020

Hello doctor,

I recently had my blood test and the results came back that I had mild neutropenia. It has got me a little concerned since this has been present on my last two blood tests with the lymphocyte count being significantly higher, but still within the normal upper limits. I have had no infections, fever, night sweats, aches, no splenomegaly and no history of anything. I currently take Propecia 1.25 mg for hair loss. My first blood test five months back was this way neutrophils 42.8 % and absolute neutrophils 2.1, lymphocytes 45.6 % and absolute lymphocytes 2.2. My newest blood test as of this week reads neutrophils 30% and absolute neutrophils 1.2, lymphocytes 59% and absolute lymphocytes 2.3. I will upload my most recent laboratory work. If more information is needed then I can get the previous one. Thank you.

#

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

  • Neutropenia is reduced neutrophils in the blood. Neutrophil is one of the five types of white blood cells (WBC) in the blood.
  • Normally, when the instrument counts the WBC, it counts 500 cells and divides the type of cells.
  • If one cell count is increased (for example lymphocytes here - normally 20-40%, here it is 59%), the other cell count will appear low (low neutrophils here). The overall cell count is good. As the lymphocytes are appearing high, the neutrophils are appearing low.
  • In neutropenia, the risk of bacterial infection is the most. Unless there is any infection, we would not worry about this count.
  • As the lymphocytes are increased, we do come across viral infections and only when the body is unable to fight it, we develop symptoms.
  • You might have a low grade viral infection, due to which lymphocytes are elevated and hence neutrophils appear to be low.
  • If you have a bacterial infection and the neutrophil does not increase, then it will be worrisome. Normally, also numerous bacterial infections are going to be around and body is responding, so there is nothing to worry about this counts.
  • The count is only relative to increased lymphocytes, hence not to be worried. If you have recurrent bacterial infections, then only neutrophil requires evaluation.
  • Looking at symptoms of night sweats, ache, splenomegaly (enlarged spleen), you might be thinking of cancer. There are no immature cells and hence, no cancer.
  • The bone marrow is functioning well as the overall count of all cells is normal.
  • Elevated vitamin B12 alone at present has no significance. If there are immature cells in blood along with vitamin B12 elevation, it would have been worrisome. At present, nothing to worry.
  • If overall WBC count falls below normal and absolute neutrophil falls below 1.0, then it is worrisome. We have seen viral infections, in which lymphocytes are 80 % to 90 % or more and neutrophils form the remaining.
  • Improve your nutrition with protein rich diet. Propecia (Finasteride) can be continued.
  • Repeat test after three months or if you get any infection. Until then improve your diet with protein.
  • It appears to be relative neutropenia due to increased lymphocyte count.

The Probable causes:

Low grade viral infections increasing lymphocytes. The normal lymphocyte count is 20% to 40% and here is 59%.

Treatment plan:

1. Improve nutrition to fight the low grade infections. 2. Maintain good hydration.

Regarding follow up:

Repeat test after three months and get back to a hematologist online.---> https://www.icliniq.com/ask-a-doctor-online/hematologist


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