Hello Worldcup78,
Relax, these results do not indicate leukemia. All your results
fall in the normal range, with the exception of a SLIGHTLY high white
blood cell count (WBC), and your eosinophils. Many people experience a
slightly elevated WBC when exposed to infectious agents (bacteria and
viruses), and are never even aware of it! Had you been exposed to a
virus, you would have had a higher lymphocyte count. The WBC
morphology was normal, as was platelet morphology. Morphology, on a
blood smear, means the size and shape of cells. Normochromic and
normocytic are terms used for red blood cells, RBCs, indicating they
are of normal color and size and shape.
You say you have no allergies, but you could have one and not know
it! Also common rheumatoid arthritis and even pinworms can cause an
elevated eosinophil (eos) count.
Elevated eosinophils can be transient, as can WBCs. Chances are good
if you have the test repeated in 2-3 weeks, you will have completely
normal results.
The Mayo Clinic states: ?Eosinophils are a type of white blood cell.
White blood cells help fight infection in your body. Although the
exact role of eosinophils is unclear, they're associated with allergic
diseases and certain types of infection. Rarely, eosinophils increase
for no apparent reason (hypereosinophilic syndrome, or HES).?
?A normal eosinophil count is less than 350 cells per microliter of
blood. Signs and symptoms of an elevated count vary widely but may
include:
? Persistent cough
? Night sweats
? Fatigue
? Decreased appetite
? Unexplained weight loss
? Abdominal pain and bloating, vomiting
http://www.mayoclinic.com/health/high-eosinophil-count/AN01060
There are two forms of eosinophilia, primary (Non-reactive) and
secondary(reactive). A dose of cortisone, given by your doctor can
help determine the difference. The eo count will decrease following
cortisone if they were elevated due to allergies.
?Causes of secondary (ie, reactive) eosinophilia include
tissue-invasive parasitosis, allergic or inflammatory conditions, and
malignancies in which eosinophils are not considered part of the
neoplastic process. Primary eosinophilia is classified operationally
into 2 categories: clonal and idiopathic. Clonal eosinophilia
stipulates the presence of either cytogenetic evidence or bone marrow
histological evidence of an otherwise classified hematologic
malignancy such as acute leukemia or a chronic myeloid disorder.
Idiopathic eosinophilia is a diagnosis of exclusion (ie, not secondary
or clonal). Hypereosinophilic syndrome is a subcategory of idiopathic
eosinophilia; diagnosis requires documentation of both sustained
eosinophilia (absolute eosinophil count > or = 1500 cells/microL for
at least 6 months) and target organ damage (eg, involvement of the
heart, lung, skin, or nerve tissue)?
http://patients.uptodate.com/abstract.asp?TR=parasite/16881&viewAbs=1&title=1
Have you recently started a new medication or supplement such as L-tryptophan?
?Eosinophilic drug reactions may be asymptomatic or associated with a
variety of syndromes, including interstitial nephritis, serum
sickness, cholestatic jaundice, hypersensitivity vasculitis, and
immunoblastic lymphadenopathy. An epidemic (several hundred cases) of
an eosinophilia-myalgia syndrome was associated with the use of
L-tryptophan for sedation or psychotropic support. The symptom complex
(severe muscle pain, tenosynovitis, muscle edema, skin rash) lasted
weeks to months, and several deaths were reported. Evidence suggests
that this condition was not caused by the L-tryptophan but by a
contaminant.?
Important differential diagnosis: ?If no underlying cause is
detected, the patient should be followed for complications. A brief
trial with low-dose corticosteroids may lower the eosinophil count if
it is reactive rather than malignant.?
http://www.merck.com/mrkshared/mmanual/section11/chapter136/136b.jsp
?Eosinophils are also known to play a role in fibrosis, thrombosis
and the activation of mast cells. The beneficial role of eosinophils
in the immunological defence against parasites is undisputed.
Eosinophils in the airways of asthmatic patients release products with
result in severe epithelial and cilial damage. Recent discoveries of
the cytokines and adhesion molecules responsible for eosinophil
activation and localization have opened up opportunities for the
production of molecules which may prevent their accumulation in
allergic diseases.
Normal Physiology
The normal eosinophil count in healthy individuals is about 150 cells
per cubic millimetre and although some normal individuals may have as
many as 800 cells per cubic millimetre, a cut-off of 400 cells per
cubic millimetre is usually taken as normal. Eosinophils usually
circulate for only a few hours and then migrate into the tissues,
where they have a life span of 2-3 days.?
http://www.allergysa.org/investigate3.htm#ecp
?Normal Adult Range: 0 - 5%
Optimal Adult Reading: 2.5?
http://www.stillsdisease.org/cbc.htm
Results can get confusing to a layman, when discussing relative
counts vs. absolute counts. The above sample count of 2.5 is the
relative percent values. As you read above, the absolute count can be
as high as 800 in normal individuals. Yours was 1,736 . Your eo count
of 14% is the relative percent count. To get the absolute count,
multiply 14% by the WBC count of 12.4 (x 10 to the 9th power) to get
1,736 per cubic mm., moderately high.
This page of the Merck Manual lists important causes of eosinophilia:
http://www.merck.com/mrkshared/mmanual/tables/136tb1.jsp
?A wide spectrum of illnesses is associated with blood eosinophilia,
including allergic conditions (eg, drug reactions), malignancies, some
connective tissue diseases, infectious diseases (especially helminthic
[worm] parasites but not protozoan parasites), and the idiopathic
hypereosinophilic syndrome (HES). A mnemonic device that the authors
created to remember the categories of diseases that sometimes are
associated with blood eosinophilia is CHINA, as follows:
? C - Connective tissue diseases
? H - Helminthic (ie, worm) infections
? I - Idiopathic HES
? N - Neoplasia
? A ? Allergies
? ?Obtaining a travel history is critical to assess whether a patient
has traveled to an area that is endemic for certain infections,
including helminthic infections and coccidioidomycosis, which is the
only fungal infection that frequently is associated with eosinophilia
and is endemic in the southwestern United States and northern Mexico.
? Obtaining a medication and diet history is crucial to evaluate for
allergic reactions associated with eosinophilia.
? Obtaining a history of symptoms associated with lymphoma, especially
Hodgkin lymphoma, is important.
? A history that is suggestive of adrenal insufficiency, including the
use and tapering of corticosteroid medications, can provide a clue
that the observed eosinophilia is associated with adrenal
insufficiency. Hypoadrenalism (ie, Addison disease) is the most common
endocrine abnormality associated with eosinophilia.?
http://www.emedicine.com/med/topic685.htm
?Eosinophils are white blood cells that participate in immunologic and
allergic events. Common causes of eosinophilia are listed in Table 2.
The relative frequency of each cause usually relates to the clinical
setting. For example, parasitic infections are often responsible for
eosinophilia in pediatric patients, and drug reactions commonly cause
an increased eosinophil count in hospitalized patients. Dermatologists
frequently find eosinophilia in patients with skin rashes, and
pulmonologists often see elevated numbers of eosinophils in
conjunction with pulmonary infiltrates and bronchoallergic reactions.?
http://www.aafp.org/afp/20001101/2053.html
?Mild (0.7-1.5 X 109/L) Allergic rhinitis
Hay fever or atopy
Extrinsic asthma
Drug reaction
Parasitic disease
Occupational lung disease
Neoplasm
Gastrointestinal disease
Skin disease
Certain infectious diseases
Long-term dialysis
Radiation therapy
Immunodeficiency state?
http://www.postgradmed.com/issues/1999/03_99/brigden.htm
?Intraindividual variation can occur within the same day or from one
day to another. For instance, serum bilirubin concentrations show a
pronounced downward trend in the afternoon; the mean value after 6 pm
is 30% lower than the mean value in the morning (11). Triglyceride,
phosphate, urea, and creatinine levels are lowest in the morning and
highest in the early evening. Hemoglobin, hematocrit, and red blood
cell count fluctuations usually repeat on a regular diurnal basis, the
morning values typically being highest. Mean leukocyte counts are
usually highest in the afternoon.?
http://www.postgradmed.com/issues/2000/06_00/brigden.htm
Here?s a bit of information on lab values:
http://web2.airmail.net/uthman/blood_cells.html
You can see an illustration of an Eo, here. (Eosinophils happen to be
my favorite white blood cell. The reddish granules actually ?glitter?
in a manual eo count!)
http://www.users.globalnet.co.uk/~aair/eosinophils.htm
Another- Note the ?drumstick? sex chromatin. This is remnants of
inactivated X chromosomes, meaning these are seen in females only!:
http://home.mc.ntu.edu.tw/~histol/Ffolder_html/blood.html
?Further tests may include blood tests to measure levels of
antibodies, stool examination, chest X-ray, CT scans of the chest and
abdomen, skin or lung biopsies, examination of the bone marrow, and
bronchoscopy.
Hypereosinophilic syndrome is a condition where there is no apparent
cause for eosinophilia. This rare condition can affect the heart,
resulting in heart failure with breathlessness and ankle swelling,
cause enlargement of the liver and spleen, resulting in swelling of
the abdomen, and give rise to skin rashes. In hypereosinophilic
syndrome there is a high risk of damage to the heart and other major
organs. In some cases a blood cell tumor known as a T-cell lymphoma
may also develop, so patients must be carefully monitored.
The conventional treatment for hypereosinophilic syndrome is oral
corticosteroid therapy. In most cases, when the cause of eosinophilia
is identified, treatment significantly reduces the symptoms of the
condition. Corticosteroids, both local (inhaled, topical), and
systemic (oral, intramuscular, intravenous), are used to manage
several allergic conditions and reduce the number of eosinophils.?
http://www.digitalnaturopath.com/cond/C657897.html
Do you have any of these symptoms?:
? Swelling and puckering of the skin, starting in the arms and legs;
may look bumpy like the skin of an orange
? Aching of the arms and legs and arthritis in the hands and wrists
? Restriction of movement of hands, wrists, elbows, ankles, and
shoulders, sometimes to the point where they can't move at all
?Eosinophilic fasciitis: What is it? (A very rare disorder)
Eosinophilic fasciitis (EF) is a disorder that causes inflammation and
thickening of the skin and tissue under the skin called fascia (which
covers the surfaces of muscles and other tissues). The inflammation is
caused by a type of white blood cell (eosinophil) which is present in
abnormally high numbers. The cause is not known, and it is rare in the
United States. Diagnosis is made by looking at a sample (biopsy) of
affected skin. It is thought that EF is a type of scleroderma.?
http://rarediseases.about.com/cs/efandems/a/060202.htm
I too, am curious about what your doctor said, and her/his plans now.
A CBC is a very routine test, and many doctors order them as part of a
check-up or yearly physical. Was there a reason other than this that
you had a CBC drawn? I would ask that your doctor repeat the test in
a few weeks, before going on to more extensive tests. Discuss your
fears with your doctor-don?t leave the office without having discussed
your results!
Wish you the best! If any part of my answer is unclear, please
request an Answer Clarification, and allow me to respond, before you
rate. I will be happy to assist you further on this question, before
you rate.
Sincerely, Crabcakes
Search Terms
=============
primary eosinophilia
secondary eosinophila
etiology eosinophilia
elevated eosinophil count |
Clarification of Answer by
crabcakes-ga
on
17 Jan 2006 09:53 PST
Hello again Worldcup,
Could you let me know where you live? (Country only, no address)
Have you traveled to areas where you may have picked up a parasitic infection?
Your blood results really do not indicate leukemia. No one can predict
if you will develop leukemia at some point in your ife however. That
could happen to any of us.
You can see from the sites I included in my answer, as well as my own
knowledge, that your slightly elevated WBC is not indicative of
anything serious, and could well be transient. And elevated Eosinophil
count is not related to leukemia.
http://www.emedicine.com/ped/topic1303.htm
It's also important to remember, in your WBC of 12.5(x 10 to the 9th
power) are included the eosinophils. 14% of those 12,500 WBCs are
eosinophils. If your eosinophils were decreased, you WBC count would
be absolutely normal.
Symptoms of CML
"Patients are often asymptomatic early on; CML may be diagnosed during
an incidental CBC. In other patients, insidious onset of nonspecific
symptoms (eg, fatigue, weakness, anorexia, weight loss, fever, night
sweats, a sense of abdominal fullness) may prompt evaluation.
Initially, pallor, bleeding, and easy bruisability and lymphadenopathy
are unusual, but moderate or occasionally extreme splenomegaly is
common (60 to 70% of cases). With disease progression, splenomegaly
may increase, and pallor and bleeding occur. Fever, marked
lymphadenopathy, and skin involvement are ominous developments."
Lab results:
In the asymptomatic patient, the WBC count is usually < 50,000/µL. In
the symptomatic patient, the WBC count is usually about 200,000/µL but
may reach 1,000,000/µL. The platelet count is normal or moderately
increased, and the Hb is usually > 10 g/dL. On blood smears, all
stages of granulocyte differentiation are seen, although in patients
with WBC counts < 50,000/µL, immature granulocytes may be uncommon.
The absolute eosinophil and basophil concentrations can be strikingly
increased, but the absolute lymphocyte and monocyte concentrations may
be normal. A few nucleated RBCs may be present, and blood cell
morphology is normal. The bone marrow is hypercellular on aspirate and
biopsy. Even at diagnosis, some patients may have some myelofibrosis.
The leukocyte alkaline phosphatase score is very low."
"Further evolution may lead to a blast crisis with myeloblasts (60% of
patients), lymphoblasts (30%), and megakaryocytoblasts (10%). In 80%
of these patients, additional chromosomal abnormalities occur
frequently."
http://www.merck.com/mrkshared/mmanual/section11/chapter138/138c.jsp
Blasts and other immature WBCs may or may not be seen in a blood
smear, if a person has a form of leukemia, depending on the stage. Did
your doctor order other tests, such as chemistry tests, including ALP,
a chem profile, liver enzymes, etc.? The technologist performing your
blood film differential would have noted if there were any signs on
CML, such as abnormal WBC morphology, NRBC -Nucleated (immature) red
blood cells, immature WBCs. This was not the case with you.
Did your doctor order anything else to determine if you really had
parasites? Not all forms of parasites cause a high Eo count. Were
stool samples collected on three occasions? Did you have a nasal
smear performed for eos? (A good way to distinguish allergy from a
cold or other symptoms).
I understand you are scared of developing leukemia, but try to
relax untill all tests are completed. As far as bruising, yes, it is a
symptom of leukemia, but it is not a diagnostic, nor exclusive to
leukemia. Many people suffer bruising, and many medications can
facilitate bruising. (Clumsy people like myself often have bruising!)
IF I were you, I would have more blood testing repeated in 2-3 weeks.
I'd have the doctor review any medications and supplements I was
taking. I'd review any symptoms with my doctor. The only way to tell
for sure if you have a form of leukemia would be to have a bone marrow
aspiration performed - expensive and painful. Insurance would not be
likely NOT to cover it if it is not indicated medically.
It's true that some people do develop leukemias and malignancies, most
do not. Wait until you have a second set of tests and proceed from
there. Remember your doctor can give you cortisone to determine if you
have primary or secondary eosinophilia.
Good luck and good health to you!
Regards, Crabcakes
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