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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10338
Experience:  14 years as clinician in the field of Family Practice
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Hello, I have had a low grade temp on and off since fri (7-26).

Customer Question

Hello, I have had a low grade temp on and off since fri (7-26). Highest 99.6 I went to ER and had labs done...what do u think of this?

WBC 12.1. (3.3-10.7)
RBI 5.36 (3.87-5.08)
Hgb 14.5
Mch 27
Rdw sd 39
Neutrophils 8.9 1.6-7.2
Immature granules 0.04 (0.00-0.03)

Does this look viral or look like an auto immune issue?
I have also had flushing on and off with temps in my cheeks. Twice my right hand got red too. No rash. This is so Wierd too because I don't get temps usually.
Submitted: 3 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 3 years ago.

Anthony Bray MD :

Hello!

Anthony Bray MD :

The elevated Neutrophils and immature granuloscytes looks more consistent with a probable bacterial infection. The temperature of 99.6 is not really that significant in itself (normal tem is 98.6 plus or minus 1.3 degrees) So really we don't TECHNICALLY define a fever until temp is 99.9or above... The source of the elevated WBC and neutrophils does warrant follow up to determine cause. This does not strike me as being likely to be an autoimmune process but this would need a different and more complete evaluation to really say... would recommend ANA/ ANCA/ Rheumatoid factor / sed rate/ C-reactive protein to evaluate this further if your symptoms warrant. Would check for urinary tract infection and respiratory infection as the most common reasons for bacterial infection.. I will be happy to discuss with you further. You accepted my answer early but you may open new thread by going to my profile page at http://www.justanswer.com/medical/expert-anthonybraymd/ and I will be happy to discuss this further with you and answer further questions that you may have. I suspect that your premature accept was by accident but after I eneter this segment the system will not let me talk further without further action on your part.. that is why I am being so long winded here! I do hope this helps! Let me know if you have further questions! Thank You and Best Regards >>Anthony Bray MD

Anthony Bray, MD and 2 other Health Specialists are ready to help you
Customer: replied 3 years ago.
Hi
Expert:  Anthony Bray, MD replied 3 years ago.
Hello!

I just entered a lengthy message to address your question. Let me go back a page and see if I may retrieve this answer. If you do not see an answer pop up in the next couple of minutes then please ask an additional question on this thread. You ACCEPTED my answer before I was able to say anything and the system is kind of messed up now...

Your pattern was more consistent with bacterial infection(High neutrophils and slightly elevated immature granulocyte..)

I advise further looking for possible urinary tract infection or possible respiratory infection (bronchitis or sinus infection as the 2 most common causes)

The temp elevation was not that significant as normal temp is a range from 98.6 plus/minus 1.3 degrees so above 99.9 is TECHNICALLY a fever.. If no source is known and you do have fever then this becomes a fever of unknown origin...

I do not strongly suspect autoimmune disease but if you have symptoms that warrant further screening along these lines may be reasonable... ANA, rheumatoid factor/ sed rate/ C-reactive protein...

I hope this plus my previous answer is helpful. Please let me know if you have further questions or discussion and i will be happy to get back with you!

Thank you and Best regards,

Anthony Bray MD
Customer: replied 3 years ago.
I don't see answer
Expert:  Anthony Bray, MD replied 3 years ago.
Hi

Hopefully you can now see my second answer>> I answered to begin with and this looks lost. I am trying to retrieve that as well...

Please bare with me!!

Hold on.. if no new message appears then please ask added question and that will allow me to respond further...

Thanks>> Anthony Bray MD
Anthony Bray, MD and 2 other Health Specialists are ready to help you
Customer: replied 3 years ago.
I can't find your first answer. I don't know what I did?
Expert:  Anthony Bray, MD replied 3 years ago.
Hello again,

It looks like my original answer was wiped out. I repeated most points in the second answer which appears above...

If you have had temp greater than 99.9 then that would be a fever...

If you have fever but source remains unknown then this would become "FEVER OF UNKNOWN ORIGIN"

I would advise that you be checked for bacterial infection with checking physical exam and particular attention to checking a urinalysis (UTI is very common cause of a bacterial infection) and also the upper respiratory tract (sinuses, throat) and lower respiratory tract (bronchitis and pneumonia are possible causes of bacterial type infection)

At this point I would not have strong reason to suspect an autoimmune disease but it would be in the differential diagnosis. Checking or screening for this group of diseases would include checking perhaps >> inflammatory markers(sed rate and C-reactive protein) // ANA // ANCA// rheumatoid factor....

I would advise follow up on the blood work to at least confirm that the MAJOR INDICES >> NEUTROPHIL count has returned to normal.. Most of the others are minor indices and do not generally play that significant of a role....

I hope this helps! Let me know if you have further questions or discussion and I will be happy to get back with you!!

Thank you and Best Regards,

Anthony Bray MD
Customer: replied 3 years ago.
I had a neg chest X-ray and urinalysis...would viral cause an elevated WBC or is nothing and just reactive?
Customer: replied 3 years ago.
? Did u get my last question? Thank you.
Expert:  Anthony Bray, MD replied 3 years ago.
Hello again,

Well a viral infection may cause your total WBC to rise BUT it general causes a rise in LYMPHOCYTES and not the NEUTROPHILS. So even though you had a negative chest x ray and U/A >> that is good BUT I would recommend a follow up to check the CBC in about 2 to 3 weeks ... as a precaution. I suspect that either A) symptoms of some infection will declare itself or more likely B) that you will feel OK and that the follow up CBC will more likely return to normal.

Sorry I had to be offline for the past 1.5 hours and was unable to get back to you sooner.

It is also possible with the type of mild elevation that you had that it could just be a stress related factor where you have a phenomenon known as demargination and have more white cells enter the bloodstream...

I hope this is helpful. Please let me know if you have further questions or discussion!! Best Regards,

Anthony Bray MD
Customer: replied 3 years ago.
Cancer would not be suspected right???? Sorry freaking out!
Expert:  Anthony Bray, MD replied 3 years ago.
Hello again!

Well as being in the medical field you and I both can recount horror stories. I do not THINK that you have reason to really be thinking cancer at this point at all... however I can't say that it would be impossible either... certain cancers such as a lymphoma might cause fever and elevation of WBC but again you are more often looking at lymphocytes with such... Other cancers >> well within an extended differential diagnosis but not really pointing to either cancer or autoimmune as being the case as being a likely scenario!!

Please try not to think the worst. I know that is easier said than done!! I don't think that the fear of the worst potentials is a particularly healthy exercise either , you know!!

Your age of 30 helps to make cancers a low risk situation for you as well!! There is nothing in your history that really is waving and red flag at me that you need to worry about the big C...

I hope that this helps! Let me know if you have further questions! Take Care. Let me know if you have further questions or discussion. Take care,

Anthony Bray MD
Customer: replied 3 years ago.
Thank u so much. I will let you know the outcome. :)
Expert:  Anthony Bray, MD replied 3 years ago.
Hi again!

OK that would be nice to hear how this follows through for you!!

Take Care,

Anthony Bray MD