Anemic, Hepatosplenomegaly, Swollen Lymph Nodes, CBC Showed Myelocytes, Other Lab Values Low. Want Your Opinion

Posted on Sun, 15 Apr 2012

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 15 Apr 2012 Answered on

Sun, 1 Jul 2012 Last reviewed on

Question : I just had a GI infection. When I could not take the nausea anymore, I went to the local ED. On arrival they gave me IVF bolus and drew a CBC. The doc came in and informed I was anemic. Hgb 6.9 HCT 21%. They were concerned d/t the fact I had myelocytes (0.06/1%). On the next day CBC was normal diff and Hgb 6 HCT 16% and that was after 50 CC blood for labs and 2 more liters of IVF. CT of my abdomen did not reveal any tumors/masses. However, I had hepatosplenomegaly. I also had 2 swollen lymph nodes in the RLQ for which they were saying it is possibly caused by infection. I received 2 units PRBC with 60 mg Prednisone PO. The next day my CBC was stable with HCT 23% (stable from my post op HCT) with no abnormal cells on my diff. The MD stated I had less hemolysis on my CBC. The hematologist stated that cancer is a VERY low possibility and I have hemolytic anemia that is exacerbated by infection. Other lab values were low hgb/low hct/elevated LDH/low haptaglobin levels/and unimpressive peripheral blood smear. I had mono 5 years ago when I was 23 and I presented with the exact issue (hgb 4.2 hct 16%, hepatosplenomegaly, swollen lymph nodes). I would like to know what your opinion is on this matter? I just need some reassurance. Thanks for your time.. XXXXXXX

Answered by Dr. Ajith Puthillath (4 hours later)

Dear XXXXXXX

Thanks for posting your query.

The combination of an increased serum Lactate Dehydrogenase (LDH) and reduced haptoglobin is 90 percent specific for diagnosing hemolysis. Response to prednisone confirms that. The peripheral smear however should have shown some evidence of this process.

Prior to the blood transfusion, generally we would like to have a coombs test that helps in the diagnosis. A reticulocyte count if ordered should have shown some elevation.

Though I do not have peripheral blood smear, reticulocyte count or coomb's test reports yet, elevated LDH and reduced haptoglobin are suggestive of hemolysis. If there is a concern for myelocytes / immature WBC then a peripheral blood flow cytometry is usually ordered.

Most hemolytic anemia respond to prednisone and prednisone should be gradually tapered. However, relapses are seen and unfortunately yet cannot be predicted.

Hope I have addressed your concern. Let me know if you have any more queries.
If all your queries are answered, please accept the answer and close the discussion.

Regards
AJ

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ajith Puthillath (57 minutes later)

Thanks AJ! I am not sure of my COOMBS test, however, my reticulocyte count was elevated. My diff was normal x 2 days and only had myelocytes in one lab report. I am not sure about the blood flow cytometry, but the MD said that my diff results were normal with less hemolysis after 1 dose of steroids. I am undergoing a hematologist wants to verify my anemia. Can you give me an opinion if you think I need to be worried about cancer? I only had the immature cells on 1 set of labs. Thanks for your response!

Answered by Dr. Ajith Puthillath (24 hours later)

Hi,
Thanks for writing back.
An elevated reticulocyte count also points towards haemolysis. I do not think that we need to be worried about cancer at this stage. The presence of myelocytes could also be due to an elevated rate of formation of blood cells during which immature forms are frequently released in the blood.
Hope this helps.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar