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Louise Sivak, M.D.
Louise Sivak, M.D., Doctor
Category: Medical
Satisfied Customers: 3499
Experience:  Pediatrician, Board-certified in Hematology/Oncology
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Low HCT (35.7) Low RBC (3.62) High lymphocytes (43.0) Reactive

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Low HCT (35.7)
Low RBC (3.62)
High lymphocytes (43.0)
Reactive lymphocytes (3.0)
Slight anisocytosis
No apparent virus (no symptoms)
Any ideas?


May I ask what is the rest of your CBC values? RDW? platelets? Total WBC and neutrophils? MCV?
Louise Sivak, M.D.

Customer: replied 6 years ago.
Thank-you for helping me.
WBC 4.6
HGB 12.0
Platelet Count 292
Platelet Estimate - Adequate
MCV 98.7 (I remember once having this value over 100)
MCH 33.1
MCHC 33.6
RDW 12.9
MPV 8.0
Neutrophils 45.0
Monocytes 8.0
Eosinophils 1.0
Basophils 0.0
Number of Cells Counted 100

There are also chemistry values and cardiac markers, all of which are normal except for glucose which is slightly low (66), however I hadn't eaten breakfast before the blood test.


Thank you for the helpful information.

Nothing in your CBC worries me for leukemia.

Your borderline low Hgb is unlikely to be due to iron deficiency (as you astutely point out) as your MCV and RDW are on the high end. Other possible causes for your anemia from this CBC alone would be B12 and/or folate deficiency. You may have had a virus like EBV or CMV (same family) but this CBC wouldn't show recent infection; that requires checking antibodies IgG (high if you've ever been exposed) and IgM (high if you've had it recently). If your creatinine and BUN are normal, it's unlikely you have kidney disease.

Any recent change in the angiomas?

If you are having symptoms related to the mild anemia like shortness of breath, inablility to do everything you want / need to w/o getting tired, then suggest your doctor check B12 and folate levels so you have a baseline rather than just starting supplements "in case".

Hope this helps and please tell me if you have more questions.

Best of luck,

Louise Sivak, M.D.

Customer: replied 6 years ago.
Thank-you so much for your answer.
I did have a bad case of mononucleosis 6 years ago, when I was 20-21. Could this cause the reactive lymphocytes now?
Relieved to know that nothing flags leukemia or kidney problems (creatinine and urea nitrogen are normal) - this is what I was most concerned about.
I take a B12 sublingual supplement every day, and have done this regularly for a long time now (since after the mono on and off for the past 6 years), so I doubt that it is B12 deficiency. I don't know what my folate levels are. I will ask the doctor to check them.
I don't know if the cherry angiomas have changed, because I only just recently noticed them. They are mainly tiny and all over my two upper arms, but I have some slightly larger ones on my back/chest/legs.
Could this also be caused by an autoimmune problem, such as rheumatoid arthritis?
Thanks again.

No the reactive lymphs are indicative of something recent or ongoing (past 3-6 weeks).

Doubt RA but unfortunately it can look like anything.

Recommend you start with the folate, and if you're concerned have your doctor recheck your CBC in 4-6 weeks when reactive lymphs should be gone. If your folate is low and the cause of your slightly higher MCV, MCV should normalize after ~2 months of folate supplements.

Best of luck,

Louise Sivak, M.D.

Louise Sivak, M.D. and 3 other Medical Specialists are ready to help you
Customer: replied 6 years ago.
Thank-you very much. I will have the doctor check my folate levels, and then will begin supplements once I have the baseline.
One last quick question - could the reactive lymphocytes and/or high lymphocyte count be due to hormonal factors - I have PCOS? Or stress? I am still a little stumped because I just haven't had any symptoms of a viral infection in the last few months.
I really appreciate your time answering my questions. I received these blood test results in the mail today and they really scared me. It is comforting to hear from someone with experience.
Thanks again.

No the reactive lymphs don't reflect hormone levels or stress in general but a normal response of the lymphocytes. If you do get another CBC checked then your doctor should do another manual differential so someone can again look at the blood smear (blood on a glass slide) under the microscope. Your reactive lymphs were 3 /100 which is pretty negligible. In a Mono (EBV) infection I typically see 15-25%.

Best of luck.

Customer: replied 6 years ago.
The doctor did ask me to have the blood rechecked in 4 weeks.
He checked off "CBCC (with automated Diff)" on the lab sheet. Is the automated differential different than the manual differential? Will this be sufficient?
Thanks again.

Whatever was done this time (auto) is fine ; sorry for my confusion. In our lab when the report notes 100 cells counted it's a manual (real person looking) diff. Then if there's any concern a hematopathologist can look him / herself. People are still better than machines for size / shape / cell "character" - anything that's beyond the basics. 3% atypical lymphs on a machine diff is even less concerning to me than on a manual but still deserves follow-up.

Customer: replied 6 years ago.
Thank-you so much, I really appreciate it!
You're very welcome.

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