Do bloodwork numbers reflect minor cold or something more?

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 percent (normal range is 40-80 percent), with high normal absolute neutrophils. My lymphocytes are more concerning, at 4 percent lymphocytes (range 2040 percent), with absolute lymphocytes of 272 (range 1,000-3,000).

I’m having recurrent lowgrade fevers (99.6-100.3) 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, and with what kind of doctor? — M.H.

DEAR READER » 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.

Being in a tropical country, you are at risk for many different infections. If you are concerned that your regular doctor lacks the expertise, you might consider an expert in infectious diseases to help evaluate your current situation.

DEAR DR. ROACH » I recently had a cataract removed in my left eye and lens-replacement surgery in both eyes. Upon completion and before the first two-week follow-up appointment, I noticed visual abnormalities — quite different in each eye — which were subsequently diagnosed as macular puckers, neither of which had been present during presurgical screening. Since there is a history of macular degeneration in my family, this outcome was said to be an “age-related” phenomenon unrelated to the surgery. Vitrectomy has been recommended for both eyes.

I’m having difficulty making the decision to go ahead with another surgical procedure. Would you please explain the mechanics or relationship of how cataract and lens-replacement surgery can lead to the condition of macular puckers? Without this information, I am thwarted in my ability to make a clear decision. — J.W.

DEAR READER » 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 that removal of the cataract made it possible for your ophthalmologist to see the macula clearly enough to make the diagnosis. The surgery, vitrectomy (removal of the vitreous fluid), usually restores about half of the lost vision. I don’t know of any other effective treatment besides surgery.