Blood test results troubling
DEAR DR. ROACH: For the second time in two years, I’ve had bloodwork done due to massive headache, general tiredness and body pains.
Both times, I also had very minor signs of a cold (post-nasal drip).
My recent test shows elevated neutrophils of 89 per cent (normal range is 40-80 per cent), with high normal absolute neutrophils.
My lymphocytes are more concerning, at four perc ent lymphocytes (range 20-40 per cent), with absolute lymphocytes of 272 (range 1,000-3,000).
I’m having recurrent lowgrade fevers (99.6-100.3 F) that seem to last only a few hours; night sweats; and am generally exhausted all the time.
I am currently in a tropical country, and am concerned at times about the care I receive here.
What follow-up care, if any, should I request here, and with what kind of doctor? I am really concerned about lymphoma, as both my mom and brother have had the disease — M.H.
ANSWER: It is difficult to evaluate your blood counts, as both times you had it done, you were sick.
A complete blood count (CBC) in a person who is sick with an acute infection often shows elevated neutrophils and low lymphocytes, so I would recommend evaluation during a time when you are well, if possible.
A hematologist is the expert in reviewing results of white blood cell (as well as red blood cell and platelet) abnormalities.
Lymphoma can cause fevers and fatigue, so it is a diagnosis that is worth considering, especially with your family history. However, being in a tropical country, you are at risk for many different infections, which may have very similar symptoms and are far more likely. If you are concerned your regular doctor lacks the expertise, you might consider an expert in infectious diseases to help evaluate your situation. A local expert certainly will know what is common where you are. DEAR DR. ROACH: I recently had a cataract removed in my left eye and lens-replacement surgery in both eyes. Upon completion , I noticed visual abnormalities — quite different in each eye — which were subsequently diagnosed as macular puckers. Since there is a history of macular degeneration in my family, a vitrectomy has now been recommended for both eyes.
Would you please explain the mechanics or relationship of how cataract and lens-replacement surgery can lead to the condition of macular puckers? — J.W.
ANSWER: Macular pucker, also called epiretinal membrane, is essentially a scar over the macula, the very center of the retina, where our vision is sharpest.
It is not related to macular degeneration, and it probably had nothing to do with the cataract surgery. Rather, it is more likely from removal of the cataract.