Hi everyone
Should I be worried by a low WBC?
I was diagnosed just over 3 years ago. I reached complete response with CTD [cyclophosphamide (Cytoxan), thalidomide, dexamethasone] and have remained so since. I have monthly bloods and Zometa, seeing the doctor every other month.
I went today for Zometa only and requested a copy of my bloods (taken yesterday) as usual. I noted that my WBC was 3.5 (the lab normal range is 4-11). This concerned me. The senior nurse, however, was not concerned and said it was fine. He said it could be low for lots of reasons and that it can fluctuate.
My WBC has never really been an issue. It was 7 on diagnosis and only dipped below 4 briefly whilst on chemotherapy. However, since ending treatment, it has always been at the low end of normal, but normal. Before today, the lowest it had been was 4.2.
All other bloods, including HB, RBC, platelets, LDH, ESR, CRP LFTs, creatinine etc are normal.
My total protein level was also normal, but my Igs were not back. My serum free light chains are tested by a different hospital and I won't get the results until next week. In the meantime, I'm panicking and thinking that my remission might be over.
Has anyone had low white blood cell counts since being in remission without it being sinister?
Thanks.
Alice
Forums
Re: Low white blood cell (WBC) count in remission
I had consistent low blood counts during remission. I think one test is probably not something to be overly concerned about.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Low white blood cell (WBC) count in remission
I have had low WBC counts for over two years since my SCT and being on Revlimid maintenance. Most of my other counts are on the low side as well but generally do better than WBC. WBC is the one I have to watch the most. Platelets sometimes get pretty low for me, RBC and hemoglobin seem to be slowly improving over the last two years.
This is fairly typical I think for most myeloma patients, especially those who have gone through SCT and are on drug therapy. Some drugs affect counts more than other, your doctor should be able to give your more details.
For me, a WBC count of 3.5 would be high, it usually is around 2.3 to 3.0. Sometimes my WBC dips to around 2.0 and a few times it has slipped below 2.0. I do start to notice it when WBC drops to 2.0 or lower. I do not feel that great, get sick easily, and sometime start running a mild temperature. 2.3 and above I feel fine and swim twice a week and bike about 50 miles on the weekend with no difficulty.
As a myeloma patient I feel you are right to keep track and be aware of what you blood count levels are, establishing a base line for what your new normal levels are and how you feel and respond to changes. It can be hard to understand and interpret the meaning of the results of these tests though.
CBC test results is one of the lab test my HMO does not post on the internet for patients to access on their own. They found when they do that their doctors would get swamped with their patients calling them in a panic about the results they see when there is no reason for concern. CBC and WBC results can vary quite a bit for a variety of reasons that are perfectly normal and expected. They prefer patients to go over the results with their doctor to explain the results in context with what the patient’s condition is and what medications they are taking. When I have asked for a hard copy of these results they have been happy to give them to me.
There is plenty of information from reputable web sites like Mayo Clinic, MD Andersen, etc about low WBC counts and how it can affect people. There are several types of WBC conditions, such as neutropenia, lymphocytopenia depending on what type of white blood cell is deficient. My recommendation would be to use these resources to get familiar the subject matter and then discuss it with your doctor so he can address what WBC means in the context of your specific condition.
This is fairly typical I think for most myeloma patients, especially those who have gone through SCT and are on drug therapy. Some drugs affect counts more than other, your doctor should be able to give your more details.
For me, a WBC count of 3.5 would be high, it usually is around 2.3 to 3.0. Sometimes my WBC dips to around 2.0 and a few times it has slipped below 2.0. I do start to notice it when WBC drops to 2.0 or lower. I do not feel that great, get sick easily, and sometime start running a mild temperature. 2.3 and above I feel fine and swim twice a week and bike about 50 miles on the weekend with no difficulty.
As a myeloma patient I feel you are right to keep track and be aware of what you blood count levels are, establishing a base line for what your new normal levels are and how you feel and respond to changes. It can be hard to understand and interpret the meaning of the results of these tests though.
CBC test results is one of the lab test my HMO does not post on the internet for patients to access on their own. They found when they do that their doctors would get swamped with their patients calling them in a panic about the results they see when there is no reason for concern. CBC and WBC results can vary quite a bit for a variety of reasons that are perfectly normal and expected. They prefer patients to go over the results with their doctor to explain the results in context with what the patient’s condition is and what medications they are taking. When I have asked for a hard copy of these results they have been happy to give them to me.
There is plenty of information from reputable web sites like Mayo Clinic, MD Andersen, etc about low WBC counts and how it can affect people. There are several types of WBC conditions, such as neutropenia, lymphocytopenia depending on what type of white blood cell is deficient. My recommendation would be to use these resources to get familiar the subject matter and then discuss it with your doctor so he can address what WBC means in the context of your specific condition.
Last edited by Eric Hofacket on Wed Jun 04, 2014 3:58 pm, edited 1 time in total.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Low white blood cell (WBC) count in remission
Probably just something that will need to be monitored with your next blood work. It is not likely to be a signal that your remission status has changed.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Low white blood cell (WBC) count in remission
Thanks guys - I feel reassured by your answers, especially Jason's! 
Eric - I'm just a couple of years younger than you. I haven't had a SCT or been on maintenance treatment. I'm aware that, statistically, I'm probably on "borrowed time" for this first remission and for that reason am results obsessed. I'm probably a bit of a control freak too, hence I always ask for copies of my results, take them home, compare them with previous results then file them away!
I don't feel unwell in any way, although I have just recovered from a cold. I've also experienced some intense stress over the last week involving my dad's health and my young pet cat being killed in a road traffic accident. Maybe these have all contributed to a lowered WBC count.
Thanks again. X
Eric - I'm just a couple of years younger than you. I haven't had a SCT or been on maintenance treatment. I'm aware that, statistically, I'm probably on "borrowed time" for this first remission and for that reason am results obsessed. I'm probably a bit of a control freak too, hence I always ask for copies of my results, take them home, compare them with previous results then file them away!
I don't feel unwell in any way, although I have just recovered from a cold. I've also experienced some intense stress over the last week involving my dad's health and my young pet cat being killed in a road traffic accident. Maybe these have all contributed to a lowered WBC count.
Thanks again. X
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AliceNorth
Re: Low white blood cell (WBC) count in remission
I believe that as a myeloma patient, tracking your CBC and WBC counts and noting how you feel and respond to drugs and disease level does not make you a control freak. I always talk with my oncologist about these lab results if I have any concerns.
While your WBC are lower than in the past they seem to still be a good enough levels. You may want to read up on the signs and symptoms of low WBC, though, and recognize when you may have them in case in the future you start trending lower to levels where it may become a problem.
I have found that when I suspected my WBC was low because of the way I was feeling, this was often confirmed by a CBC or WBC lab result when I went into Urgent Care for some aliment. A low grade fever, runny nose, mouth sores and more fatigue that normal are typical systems of low WBC. I have had all the above except mouth sores.
My levels have not been critically low though, just low enough a few times to take extra precautions to avoid infectious situations and get some extra rest.
While your WBC are lower than in the past they seem to still be a good enough levels. You may want to read up on the signs and symptoms of low WBC, though, and recognize when you may have them in case in the future you start trending lower to levels where it may become a problem.
I have found that when I suspected my WBC was low because of the way I was feeling, this was often confirmed by a CBC or WBC lab result when I went into Urgent Care for some aliment. A low grade fever, runny nose, mouth sores and more fatigue that normal are typical systems of low WBC. I have had all the above except mouth sores.
My levels have not been critically low though, just low enough a few times to take extra precautions to avoid infectious situations and get some extra rest.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Low white blood cell (WBC) count in remission
Thanks again for the replies, Eric and your very helpful advice.
I found it very interesting what you said earlier about your centre not posting CBC results. I did have a chuckle because I'm very much like that with my doctor when I see him - asking about any result that is slightly out, or has increased/decreased. I know he gets exasperated, but not in a nasty way. Just a couple of months ago, he more or less said "they are just numbers. Now go away and live your life".
My husband thinks that analysing each blood result is detrimental to my mental health. He seriously thinks that I should not ask for my results and simply request a "thumbs up" or a "thumbs down". I simply don't and can't agree to that and it is clear that very few patients at my hospital ask for hard copies of results. I suspect that this may be to do with the age of the vast majority of his patients and I absolutely mean no disrespect in saying that.
My local oncologist (who does have an interest in myeloma) is the doctor I see most regularly. However I do see a myeloma specialist further afield from time to time. He once put test results into perspective by saying that if his bloods were taken on any given day, he could guarantee that there would be some abnormal results.
Best wishes
Alice
I found it very interesting what you said earlier about your centre not posting CBC results. I did have a chuckle because I'm very much like that with my doctor when I see him - asking about any result that is slightly out, or has increased/decreased. I know he gets exasperated, but not in a nasty way. Just a couple of months ago, he more or less said "they are just numbers. Now go away and live your life".
My husband thinks that analysing each blood result is detrimental to my mental health. He seriously thinks that I should not ask for my results and simply request a "thumbs up" or a "thumbs down". I simply don't and can't agree to that and it is clear that very few patients at my hospital ask for hard copies of results. I suspect that this may be to do with the age of the vast majority of his patients and I absolutely mean no disrespect in saying that.
My local oncologist (who does have an interest in myeloma) is the doctor I see most regularly. However I do see a myeloma specialist further afield from time to time. He once put test results into perspective by saying that if his bloods were taken on any given day, he could guarantee that there would be some abnormal results.
Best wishes
Alice
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AliceNorth
Re: Low white blood cell (WBC) count in remission
Just a quick update, in case it helps anyone else. My serum FLC results came back today as normal (with normal ratio) and no pp detected. Thanks everyone 
Alice
Alice
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AliceNorth
Re: Low white blood cell (WBC) count in remission
Thanks for your update as well, AliceNorth.
Did you share it with your husband?
Did you share it with your husband?
Re: Low white blood cell (WBC) count in remission
Well, I hope this turns out to be nothing. I had my auto stem cell transplant in March of this year. All went well. I had an almost complete remission. I still carry a very low M-spike of about 0.15 g/dl (1.5 g/l). Which may just be my 'normal'. I am not on any maintenance therapy, and I am with a respected myeloma specialist.
My blood work has been normal the past 9 months, and 3 weeks ago was still normal. Yesterday, I was tested and my WBC is down to 2.5, neutrophils are at 1.2.
I am hoping this might be because I had the stomach flu 24 hours before this blood test? I know that some viruses can affect the WBC?
Anyone have any insights?
My blood work has been normal the past 9 months, and 3 weeks ago was still normal. Yesterday, I was tested and my WBC is down to 2.5, neutrophils are at 1.2.
I am hoping this might be because I had the stomach flu 24 hours before this blood test? I know that some viruses can affect the WBC?
Anyone have any insights?
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