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Doctors' Answers to "Frequently Asked Questions" - WBC


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/4/2000]
Question: I recently found out I have a low white blood cell count and have read that alkaloids found in ephedrine can contribute to this problem. I take Claritin-D daily and wonder if there could be a connection.

Answer: Probably not, but easily checked by stopping it for several weeks and rechecking the white count.

[posted 04/5/2000]
Question: I recently had bloodwork done and my WBC was 5.9.I suffer
from chronic sinus infections and a recurring uterine
infection.I feel tired and weak almost daily.What can be
causing this low count?Could all these infections do it?


Answer: This isn't particularly low, depending on the subclasses of white cells(lymphocytes, neutrophils etc.). Wht is the differential?

[posted 03/26/2000]
Question: I was wondering if an apparently normal low white blood cell count can be improved by eating or supplements. My count is 3.7 (I guess that means 3700). When that \\# came back in my blood test a couple weeks ago, my doctor had it retested to make certain of the number. When the retest came back w/ the same \\#, he checked my history (back to 1995) and found the same low \\#s. I am 57, very physically fit and healthy, and work towards a healthy life style. Thank you very much.

Answer: There's not usually anything that can be done about this(or should be). The "normal" lab values are designed to cover 95% confidence intervals. That is, if you look at a Bell Curve Distribution, 2 1/2 standard deviations cover 95% of the curve. That means that 5% of the time there will be "abnormal" test values that don't actually mean there is an abnormality. If you don't have infections and this is a long term issue, this is probably normal for you(probably the rest of your family too if you were to check).

[posted 03/9/2000]
Question: Dear Doc, I had a high risk sexual encounter (with someone of unknown HIV status in June 1999) and about 10 days later had a harsh viral syndrome of headaches, fever, fatigue, body & muscle & joint aches, lost 12 lbs. in 2 weeks, lost appetite for 3 weeks, and had a sore throat for 4 months. Only the sore throat was long and the other symptoms went away in 2 weeks. However, now, 8 months later I am getting pains in my right forearm, that comes and goes throughout the day and presumes in the right wrist area and sometimes in the palm of my hand. it's a feeling of nerve pain/burning pain/bruising pain-like feeling. I got tested for HIV and all viral hepatises and everything was negative in Sept. '99. However, my alt and ast were elevated at 80 and 90 respectively. My total protein was at 8.6 (elevated) and globulin was also elevated. My WBC was 6.0 in Sept. Then in Dec., had same tests repeated and liver enzymes were back down to normal, but total protein and globulin still were elevated, but the WBC was down to 4.0 (normal being 4.8 on low end). This concerned me as I have read that HIV can cause lowered WBC. Differential were normal however. HIV test in Dec. was negative at 6 months. My ID doc did a monospot check in Dec. and it was negative, and later in Dec. did an Epstein-Barr panel, this revealed that the IGM was negative to VCA, IGG was positve to VCA, and early antigen (IFA??) were positive. My question to you is: 1)I understand that IGM is present early only, but does early antigen IFA stay positive for life like IGG, or do they go away after several months?? I've heard to sides to this and am confused. 2)I read in FAQ that lowered WBC is classic of post-viral infection. But how long does WBC stay low after viral infections because mine was at 4.0 in Nov., Dec., Jan., and Feb. at 4.2 to 3.8 recently. 3) does the pain in my right forearm and wrist and hand sound like neuropathy? it's only isolated on the right hand and is scaring me. 4) do you think HIV has been officially ruled out? even type o or type n, the foreign strains? Thanks for your time, I am severely depressed due to ongoing nerve/pain in my right arm and just can't get on with life for the past 8 months. I really appreciate a response to the above 4 questions. Thanks doc.

Answer: First of all, you need to know what your wbc count was before this episode. By definition, 5% of patients will have an "abnormal" level. That is, the lab standards are set at 95% standard deviations so that they will not be too wide, or too narrow. Hence 5% are "abnormal". However, you may have had this level your whole life. I wouldn't focus too much on it unless you are losing weight, having fevers etc. probably of no significance what so ever. As to the pain, hard to know without a neurologic exam- has this been done? The HIV is out of the picture at this point (at least from that contact) ensure you have been checked for syphilis for completeness. I would not worry about the Ebstein Barr, that is also of no consequence at this point.

[posted 08/12/1999]
Question: Hello, I am having problems with an elevated white count. Last November I had what was described as a siezure and was admitted to the hospital. They did routine blood work and my WBC was 24,500. They kept me over night and by morning it was down to 12,000. Brain scans etc. showed nothing and I was released. I had another test a few days later and it was up again than came down again. Last night I went to the emergency room due to a pain in my right side and back and sure enough white count back to 23,000. Todays blood test was down to 8,000. What is going on with my white blood cells?

Any thoughts or suggestions would be appreciated.

Thank You

Answer: Don't know, but someone needs to examine you-not in the emergency room. Might be all just stress reaction which would be normal, but you need someone to check your spleen, other lymph nodes, and do some repeat counts as a minimun.

WBC
Question: My hb is normal, but my wbc count is 2 .1. What does this indicate and should I be concerned?

Answer: This is certainly unusual. What is the differential? If one area is very low, look into it. However, some patients experience this low a count. I'd check it occasionally and ensure that you have had a complete physical. If it drops lower (or if the differential shows a sub-group very low) see a hematologist. Having said that, you probably won't find any particular problem. The most common cause is post-viral infection, so check it a few times before you get excited.

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