Persistent relative lymphocytosis/neutropenia? Elevated T Cell Counts?

[acer2000]

Before I got sick, my neutrophil percentage was always higher than my lymphocyte percentage. I am told in adults, this is normal. Then starting soon after I got sick, this reversed. Now very often my Lymph% is above range and my Neut% is below. I also have immune panels that show elevated CD3 and CD4 T cell subsets. My doctor was concerned enough to refer me to a hematologist, who said that my smear showed normal cells. He referred me to have a PET/CT scan, which was normal. Can anyone provide any insight on what this means? I can't seem to find any good information.

For example:

Neutrophil % 36.0-71.0 % 34.9 ***
Lymphocyte % 20.0-50.0 % 52.7 ***

WBC Count 4.0-10.0 K/uL 6.7
Imm Granulocyte % 0.0-1.0 % 0.1
Monocyte % 6.0-13.0 % 8.0
Eosinophil % 0.0-6.0 % 3.7
Basophil % 0.0-1.0 % 0.6
Absolute Neutrophil Count 1.5-7.2 K/uL 2.3
Absolute Lymphocyte Count 1.2-4.0 K/uL 3.6
Absolute Monocyte Count 0.1-1.1 K/uL 0.5
Absolute Eosinophil Count 0.0-0.5 K/uL 0.2
Absolute Basophil Count 0.0-0.2 K/uL 0.0
Absolute Imm Gran Count 0.0-0.1 K/uL 0.0

Lymphocyte Population Antigen Sublineage Result H/L Normal Unit Range
CD3 T Cell 79.9 H 59-79 % ***
CD4 T-Helper/Inducer 52.2 H 36-52 % ***
CD8 T-Suppressor/Cytotoxic 26.2 19-29 %
CD19 B Cell 13.3 H 3-13 % ***
CD16,56 NK Cell 6
CD4:CD8 Ratio 1.99 1.2-2.6
Absolute Value ------------------------ .
CD3,Abs T Cell 2237 H 822-1902 cells/cmm ***
CD4,Abs T-Helper/Inducer 1462 H 517-1169 cells/cmm ***
CD8,Abs T-Suppressor/Cytotoxic 734 H 255-649 cells/cmm ***
CD19,Abs B Cell 372 H 1-354 cells/cmm ***
CD16,56,Abs NK Cell 168 cells/cmm

I have at times also had elevated ALT liver enzymes and also IL-8 when it was tested.

 

[heapsreal]

I have/had similar blood work and my doc said my blood work looked like some type of ongoing infection. Other testing showed ebv and cmv which kickstarted cfs off for me along with chickenpox. Several years later i had titres measured which showed cmv was still high and considered active infection. For me antivirals have brought these tests closer to normal and an improvement in general symptoms.

Most doctors would probably say its nothing to worry about and your just getting over a cold, but if your labs have been like this for awhile than its possible its some type of ongoing infection?

I guess the next step for yourself is to get more testing done looking for infections. Liver enzymes can go up with infections also and common in herpes infections like ebv/cmv/hhv6?? Elevated lymphocytes are common in viral infections. Neutrophils are commonly high in infections also but can also go low, generally bacterial infections affect neutrophils but herpes viruses also commonly affect neutrophils.

Just noticed granulocytes are low, your immune system makes neutrophils from granulocytes, could be a horse or the cart thing but again probably related to infections. Some medications can lower neutrophils also.

What triggered your cfs? What are your main ongoing symptoms? Any other tests you have had in the past, infections etc?

 

[melamine]

A decreased percentage of neutrophils may be due to:

• Aplastic anemia
• Chemotherapy
• Influenza
• Radiation therapy or exposure
• Viral infection
• Widespread severe bacterial infection

An increased percentage of lymphocytes may be due to:

• Chronic bacterial infection
• Infectious hepatitis
• Infectious mononucleosis
• Lymphocytic leukemia
• Multiple myeloma
• Viral infection (such as mumps or measles)

http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm

 

[acer2000]

My illness started about 5 months after I had surgery in 2006 with chills and sudden onset of fatigue and brain fog. Prior to that (but still post op) I had new onset GI symptoms, headaches, and right upper quadrant abdominal pain. Sometimes I also have a sore throat and I have bumps that I can feel on my soft palate. I also have circles around my eyes. During the surgery I had 4 units of blood transfused.

I have been tested for lots of viral infections (incl herpes viruses and other "usual suspects" such as HIV and hepatitis), but nothing has come up as active. Lyme and friends tests have been negative. I even took Valcyte for a while and it didn't do anything. IVIG made me very anxious (odd) but didn't improve my symptoms. I guess I need a better way to figure out an infection, but I can't seem to find one.

 

[halcyon]

I have been tested for lots of viral infections (incl herpes viruses and other "usual suspects" such as HIV and hepatitis), but nothing has come up as active.

Have you been tested for enterovirus?

 

[acer2000]

I was tested for enterovirus. The titers weren't all that impressive. I continue to show this pattern. My most recent neutrophil count was 1.8 which is kind of low. My total WBC was 5.3 and the lymphs were 2.8. Relative neutrophils were 34.6 and lymphs were 53.3.

I was even in a study where they ran my blood against a viral "chip" and they claim not to have found anything. So I guess if I can trust that study I didn't have any notable virus, at least in my blood at the time they drew it.

 

[halcyon]

I was even in a study where they ran my blood against a viral "chip" and they claim not to have found anything. So I guess if I can trust that study I didn't have any notable virus, at least in my blood at the time they drew it.

Blood based tests in chronic infections often turn up nothing, even when there is an infection in the tissue.

 

[acer2000]

Has this been a pattern that shows up in people with EV infections? Does it have any predictive value as to if they will respond to treatment?

 

[acer2000]

Also, I have read that elevated CD4 counts can be a nonspecific indication of autoimmune pathology? But perhaps not in the presence of also increased CD8 cells? All of my autoimmune markers have been negative and I have a low ESR. Is anyone more familiar with this who can point me to some info?

 

[halcyon]

I'm not sure if it's really been studied in the context of enterovirus infections. Dr. Chia has done a little work in the area, showing that upon initial infection there is a depletion of lymphocytes, specifically CD8+ T cells . I can only tell you what my pattern looked like. During the acute stage of my echovirus infection, I did have the transient lymphocytopenia. This resolved over the course of a few months, unfortunately I didn't have extensive subset testing done at that time. By the time the infection had become chronic, about 5 months later, I had normal CD4+ T cell levels but elevated CD8+ levels. Like you I have low ESR and no signs of autoimmunity. I have seen a case report of one of Dr. Chia's patients that had an enterovirus infection but normal CD4/CD8. It probably just depends on the person and I'm not sure how much can really be inferred from these tests. CD8+ T cells are thought to be important cells for fighting viruses so an elevation of those could potentially point to a viral cause.