It’s time for a specialist to look

Dear Dr. Roach: In 2017, my white blood cell count was 8.9 and my lymphocytes were 3.2. My recent blood tests showed a second increase in both numbers, with the WBC 10.2 and lymphocytes 4.8. My doctor said he has many patients who are 70 and older with increased levels and that we will flag it for a follow up next year. What else could be done to locate the source of infection/inflammation, and is there anything I can do? I am healthy, active and not overweight. — D.H.

The lymphocytes are one of the two major types of white blood cells. The other is granulocytes. A normal level is around 2,000. Over 4,000 is in the abnormal range, and I would not wait another year before doing an evaluation.

Infection and inflammation are indeed causes of high lymphocyte counts; however, as your levels have been steadily increasing over three years, I think an unsuspected infection is unlikely. You haven’t mentioned any medications you take, but there are several that can cause this reaction. Seizure medicines and antibiotics are among the more common. There also are a variety of blood disorders that can cause an elevation.

It’s time to see a hematologist to begin an evaluation. The first step is to (literally) look at the lymphocytes in the blood. An experienced hematologist or hematopathologist can often narrow down the causes with a look at the blood smear. Further testing, including flow cytometry and bone marrow biopsy, may be done.

Lymphocyte counts of 5,000 or higher are suggestive of chronic lymphocytic leukemia, which sounds very scary. But, cases of CLL caught early and without symptoms are observed rather than treated. Some people with CLL live decades before having any symptoms from the disease. Others require treatment in order to slow progression.