What is this? Weird bloodwork numbers, not much help from docs
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Anonymous
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DCUM armchair doctors, what do you think?
MIL lives out of town, and was admitted to the hospital last week after she reported feeling under the weather and her CBC showed a white blood cell count that was off the charts. (Maybe she started at her PCP? A little unclear on how/why the saga began.) They kept her two nights for observation and testing, including a bone marrow test because one doctor mentioned leukemia as a possible explanation. At some point, they decided that the tests didn't indicate anything serious and sent her home. Today, she's back in the hospital because she felt incredibly fatigued and now her RED blood cell count is really LOW. Again, the doctors are planning a bunch of tests and suggesting really scary diagnoses. With the exception of these wonky bloodwork numbers and the general feeling of being unwell, she's been very healthy. She's in her early 70s, vaccinated and boosted, golfs and swims regularly, hasn't had any other recent symptoms. She had a mini stroke about 3 years ago but recovered extremely well. We're a plane ride away and are feeling frustrated that we're not able to help, or at least sit in on the meetings with the doctors. Any idea what could be going on? How can we best support her and ask helpful questions? |
Anonymous
| There is an undiagnosed infection. Does she have any artificial valves, hips, or other hardware? |
Anonymous
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Any vomiting? Could there be a carbon monoxide leak in her house?
Any other symptoms other than fatigue? |
Anonymous
She has all her original parts; no upgrades so far. I agree that the high white count seems to indicate an infection, but from what we understand she hasn't been sick (chronically or acutely) until all this, and doesn't seem to have any other symptoms. |
Anonymous
I don't think there's been any vomiting. Good question about the carbon monoxide leak; I just finished that article in the WaPo health section today. It doesn't sound like there have been any other symptoms or complaints, but maybe we're not getting the full story. |
Anonymous
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Well, the first procedure in the House of God is to take your own pulse.
You are missing a ton of information here, OP. My thought is that two back to back hospital admissions warrants a flight out to visit and see how sick she really is right now. |
Anonymous
Didn't realize CO was in the news. Here's the UpToDate on CO poisoning in case helpful/of interest: https://www.uptodate.com/contents/carbon-monoxide-poisoning |
Anonymous
| Hemolytic anemia? Is she eating or drinking anything new? Taking any new meds? Could she be G6PD deficient and has she eaten large quantities of fava beans or anything with quinine (like tonic water) or any other G6PD-related hemolytic anemia triggers? G6PD deficiency is the most common enzyme deficiency in humans. |
Anonymous
| Good that the doctors are doing a bunch of tests to rule out serious conditions. Is she at a good hospital? Does she have someone with her who can advocate? |
Anonymous
| My daughter had an off the charts wbc 7 weeks after a virus. She was in the hospital to rule out anything else and they concluded it was still from the virus. Months later and her counts have all returned to normal and stayed that way |
Anonymous
You’re right about missing info. I feel like right now, we don’t know what we don’t know. We are fortunate that one of DH’s siblings lives very close to her, so she does have someone there to help out with all this. But it’s been challenging for us to keep up from afar. |
Anonymous
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Part of my practice involves diagnosing leukemia and lymphoma.
Unfortunately, this is far, far too little information for anyone to give a thoughtful differential diagnosis. “Off the charts” is too vague (WBC of 20K/uL and 200K/uL could both be called “off the charts” by a PCP, but 20K could be an infection and 200K would not be an infection), the type of WBCs that are elevated isn’t specified (neutrophils, lymphocytes, blasts, etc), it’s not clear if the anemia just started in the last day or so or if it is progressive, what kind of anemia (macrocytic, microcytic, RDW?), do labs suggest hemolysis, what is the platelet count, is there basophilia, is there splenomegaly, has someone done FISH for BCR-ABL1 translocation (if neutrophils and their precursors are elevated), has anyone done flow cytometry on the peripheral blood, what are the results of the bone marrow biopsy? And I could keep going. I would recommend insisting that you talk to the doctor. Being aware that it can take a while to get all of the information back and come up with a diagnosis. I’m sorry that I cannot be more helpful. Best of luck; I hope that it’s just an infection that gets better. |
Anonymous
Thank you, Dr. OP, for your great breakdown of factors to consider and questions to ask. She sent us three pages of lab report last night, but they were blurry and very difficult to read. Trying this morning for some more clarity, info and clear next steps. I really appreciate everyone’s suggestions and thoughts. My MIL isn’t especially comfortable with doctors, complex terminology, and evidence-based health stuff in general. We are glad to have family there with her, but are trying to also find a way to keep up and support her/BIL from far away. |
Anonymous
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Urinary tract infections are very common in older people, and often present vague symptoms that are very different from the burning or feeling of urgency that younger people experience. My elderly Dad became confused, fell, and generally felt “off”. Bloodwork showed a raging infection and it turns out it was a UTI.
I hope that it’s something easily treatable, but I agree with PP that you should plan to visit her and check on her. |
Anonymous
| Most places have mychart or something similar. Make sure she is set up on that and then you can look at results as well. |