How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Louise Sivak, M.D. Your Own Question

Louise Sivak, M.D.
Louise Sivak, M.D., Doctor
Category: Medical
Satisfied Customers: 3498
Experience:  Pediatrician, Board-certified in Hematology/Oncology
16877601
Type Your Medical Question Here...
Louise Sivak, M.D. is online now
A new question is answered every 9 seconds

Low HCT (35.7) Low RBC (3.62) High lymphocytes (43.0) Reactive

Customer Question

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?
Thank-you
Submitted: 4 years ago.
Category: Medical
Expert:  Louise Sivak, M.D. replied 4 years ago.

Hello,

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

Customer: replied 4 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.
Expert:  Louise Sivak, M.D. replied 4 years ago.

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 4 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.
Expert:  Louise Sivak, M.D. replied 4 years ago.

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., Doctor
Category: Medical
Satisfied Customers: 3498
Experience: Pediatrician, Board-certified in Hematology/Oncology
Louise Sivak, M.D. and 9 other Medical Specialists are ready to help you
Customer: replied 4 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.
Expert:  Louise Sivak, M.D. replied 4 years ago.

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 4 years ago.
Thank-you.
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.
Expert:  Louise Sivak, M.D. replied 4 years ago.

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 4 years ago.
Thank-you so much, I really appreciate it!
Expert:  Louise Sivak, M.D. replied 4 years ago.
You're very welcome.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.
 
 
 

Related Medical Questions