pancakes Posted August 29, 2017 Share Posted August 29, 2017 24 y/o female with h/o iron deficiency. Had a CBC with Diff. In 6 months, Baso increased 1.0-1.1%. Eosinophil increased from 3.1%-8.8%. Lymph decreased from 45.4%-44.4%. ABS neut% decreased from 1.30 - 0.99. . Platelet count has steadily been decreasing from 253 month 1 to 197 month 3 (she had wisdom tooth surgery a week before the draw) to 181 at month 6. WBC has also decreased from 2.91 - 2.61. She was being treated for her iron deficiency and RBC values/h&h look good. No other history of health problems or trauma. The only medications she was on at the time was her ferrous sulfate 325mg once daily and she used some ear drops. Not a smoker or a drinker. Denies recent illnesses. No blood in urine or stool. Not pregnant. Extremely stressed out and low on sleep at the time of the last draw. Based on lab values, the only things out of range are abs neut and WBC. Eosinophil is at 8.8% but abs eosinophil is normal... Why is WBC decreasing but eosinophil increasing? Platelet count is still within normal range but the drop has been extremely rapid, IMO. Cutoff for normal range for the lab is 150. She dropped from 253 to 181 in 6 months. WBC has been low since the start (which she was told by a previous provider not to worry about) but it's continuing to drop which is concerning, especially with no other signs or symptoms. I have no clue on how to approach this. Any insight?? Link to comment Share on other sites More sharing options...
Kaepora Posted August 29, 2017 Share Posted August 29, 2017 Appetite? Weight changes? Occupation? Travel history? Do you have an etiology for the iron deficiency anemia? Link to comment Share on other sites More sharing options...
pancakes Posted August 30, 2017 Author Share Posted August 30, 2017 Normal appetite. Has gradually lost 77 pounds over the past 7 years through exercise and portion control. Denies recent travel. Low on iron (perhaps through her diet) Link to comment Share on other sites More sharing options...
Kaepora Posted August 30, 2017 Share Posted August 30, 2017 21 minutes ago, pancakes said: Low on iron (perhaps through her diet) So was she worked up for this or no? I'm assuming her MCV was low and a ferritin level drawn? Was it due to heavy menstruation? Any associated GI symptoms or occult bleeding? Inflammation? I don't want to go down the rabbit hole here but we can't help too much without more info. Link to comment Share on other sites More sharing options...
pancakes Posted August 30, 2017 Author Share Posted August 30, 2017 Right, so she had a previous history of iron deficiency in high school which was treated. Now at 24, her MCV and H&H, etc. were all over the chart on month 1. She was put on ferrous sulfate 325mg one tablet daily for 6 months. She had her blood drawn at month 3 to if the anemia was improving with the pills, and was kept on the the tx for another 3 months, which brought her in for her 6 month blood draw that I have listed the results to above. Her RBC, H&H, MCV, MCHC, MCV, MPV are all within normal range now and she is off the ferrous sulfate. Ferritin levels were drawn and they were fine. Menstruation used to be very heavy but has gotten lighter throughout the years. No inflammation. She was recently tested for celiac. Results were negative. She believes she has "some sort of IBS." Bowel movements have not changed. The information may be scattered, so I apologize! I have been going through this for what seems like eons and I can't figure it out. Link to comment Share on other sites More sharing options...
8404PA Posted August 30, 2017 Share Posted August 30, 2017 Eosinophilic leukemia or parasitic infection? Check ECG, bone marrow bx, IgE, Serum tryptase, Immunophenotyping of peripheral blood T cells Spitballing, still in didactic so I have a narrow view. Link to comment Share on other sites More sharing options...
pancakes Posted August 30, 2017 Author Share Posted August 30, 2017 8404PA - I'm ruling out Eosinophilic leukemia just because she has no fever, muscle aches, cough, SOB, etc. Link to comment Share on other sites More sharing options...
MCHAD Posted August 30, 2017 Share Posted August 30, 2017 The number of eosinophils didn't increase...the number of another type of WBC decreased causing the percentage of eosinophils in relation to others rise Link to comment Share on other sites More sharing options...
MCHAD Posted August 30, 2017 Share Posted August 30, 2017 And by abs neut % do you mean ANC or absolute neutrophil count? This isn't a percentage if so and neutrophil % is very different from ANC Link to comment Share on other sites More sharing options...
pancakes Posted August 30, 2017 Author Share Posted August 30, 2017 abs neut meaning ANC. A little bit more reader friendly: over a 6 month period WBC: 2.91 -> 2.61k/uL Platelet: 253 -> 181k/uL (still within range) Neut%: 44.7 -> 38% Abs Neut (ANC): 1.30 ->0.99k/uL Lymph%: 45.4 -> 44.4% Abs Lymph: 1.32 -> 1.16k/uL Mono%: 5.8 -> 7.7% Abs Mono: 0.17 -> 0.20k/uL Eosin %: 3.1 -> 8.8% Abs Eosin: 0.09 -> 0.23k/uL Baso %: 1.0 -> 1.1% Abs Baso: Unchanged at 0.03k/uL Link to comment Share on other sites More sharing options...
8404PA Posted August 31, 2017 Share Posted August 31, 2017 Consulted a professor, and prior lab tech. His primary ddx is parasitic infection. Link to comment Share on other sites More sharing options...
pancakes Posted September 1, 2017 Author Share Posted September 1, 2017 Someone said test her for HIV but she has none of the symptoms? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 1, 2017 Share Posted September 1, 2017 NAACP. What does the "P" stand for with abnormal neutrophils? You have your answer.Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
MT2PA Posted September 2, 2017 Share Posted September 2, 2017 FWIW I'm not sure a plt drop of 250ish to 180ish over 6 months constitutes 'rapid'. If there's no parasitiic (or other) infection, I'd think a BM biopsy might be justified at some point if the #s keep dropping. Also, plenty of people don't have symptoms with HIV unless it's the very early acute phase illness or very late stage. Not sure that is what's causing things here, but that's why patients get screened regularly - otherwise you might not know until it's too late. Link to comment Share on other sites More sharing options...
Kaepora Posted September 2, 2017 Share Posted September 2, 2017 I would say the lab work is not overly impressive. If her travel history isn't significant, if she doesn't eat off the wall foods like raw or undercooked meats, and if she doesn't have any other concerning constitutional symptoms (like for myeloproliferative disorders, etc), just give her reassurance and f/u with blood work at a later date. I do like the idea of screening for HIV if she hasn't recently. Link to comment Share on other sites More sharing options...
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