Birthday Weekend: Part I

Friday was not a good day.

It was my birthday and the well-wishers poured in like a Miami rainstorm. But I wasn’t in the mood for talking. In fact, I waited for someone to wish me, “Have an unhappy birthday!”

It was a mistake not just on my husband’s part, but mine as well. I was supposed to go to work for my birthday and celebrate with my co-workers but I woke up groggy and my husband immediately assumed that I was coming down with a bad cold or flu or something. I slept and all morning then woke up in the late afternoon. Waking up in the middle of the afternoon after my husband called in sick for me just didn’t make me feel right.

I had a doctor’s appointment at around 3:15 and the news was somewhat hopeful. But at the same time, it raised tiny concerns. I have a low white blood cell count (WBC) that’s been raising some eyebrows. At my last appointment a few weeks ago, my primary care doctor was kind enough to assume, “Hey, it’s probably just your normal WBC or your body’s fighting off an infection, but I’m sending you to a hematologist just to cover all our bases.”

Because of my line of work, I am familiar with reading complete blood count (CBC) data.

Off to the hematologist I went on Friday. My husband took the day off and went with me (he’d had an inlay put in earlier that day). I sat in the waiting room for a half-hour, sulking. Sulking more because I was in a foul mood of not going to work than the long wait. As restitution for my long wait, the doctor was kind enough to offer me Girl Scout de-lite cookies, which despite my aversion to chocolate, I fell in love with. (I’m purposely not buying them lest I blow my recent weight loss.)

The PCP office faxed my lab records from July 2006 and January 2007. My WBC in July was 3.7%. By January, my WBC had dipped down to 3.3%. Considering that the normal range is between 4.0-10.4, the low leukocyte count raised some eyebrows but wasn’t immediate cause for concern. My hematologist laid down the law:

“The normal range is 4.0-10, but it’s based on the average blood cell count of a Caucasian. African-Americans tend to have a lower count, on average.”

Okay, so that’s not so bad. I haven’t been freaking out really. I have severe eczema on different parts of my body (mainly my legs and back these days) so I figure my WBC will always be a little on the low side because I bleed at least once a day and my WBCs say, “Oh no! Platelets and white blood cell counts come together now to fight the evil infection!” The low leukocyte range doesn’t scare me.

What does scare me is a continued dip in my WBC. I’ve got a follow-up hematologist appointment in July. I need to get blood work done sometime in June. If my WBC count dips below 3.3, approaches 3.0, or worse – make a rapid turn for the worse at 2.2 – I’ve got to have – ack! – a bone marrow biopsy.

On the least-to-most invasive scale, a bone marrow biopsy doesn’t sound particularly non-invasive. MedlinePlus’ description doesn’t ease my fears either.

But I may be freaking out over nothing. FEAR means False Evidence Appearing Real, right?

So for now, I’m just going la-dee-da with my leukocyte count lest my results turn up – or turn down, for that matter – in a negative fashion.

Dr. Hematologist was kind enough to provide me with my diagnosis (ICD9) code. 288.5. I really didn’t need to look it up. On one of her papers, I noticed her write down “leukopenia.” The name and code stuck with me as I went home. 288.5, leukopenia, 288.5, leukopenia.

I immediately scoured icd9data.com for what 288.5 means. It describes 288.5 as “a non-specific code that cannot be used to specify a diagnosis, which excludes neutropenia.” Then I got curious and wondered how 288.50 was different from 288.5. It was somewhat different and accurately described the leukopenia diagnosis I’d seen.

“Leukocytopenia, unspecified

    * 288.50 is a specific code that can be used to specify a diagnosis

Alternate Terminology

    * Decreased leukocytes, unspecified
    * Decreased white blood cell count, unspecified
    * Leukopenia NOS”

So I thought to myself, Oh, cool. OK, It just means I have a low WBC that’s not otherwise specified. That sounds harmless. Although I know leukopenia (MS Word only recognizes leucopenia – *sigh*) just means low white blood cell count, I got curious to see what it could mean. So I trekked on over to my all-knowing wikipedia for further information. The wikipedia entry answered some questions I’d had for years: Why was I always prone to getting sick?

“As the principal function of white cells is to combat infection, a decrease in the number of these cells can place patients at increased risk for infection.”

And the entry went on:

“Low white cell counts are associated with chemotherapy, radiation therapy, leukemia (as malignant cells overwhelm the bone marrow), myelofibrosis and aplastic anemia (destruction of the bone marrow by the immune system). In addition, many common medications can cause leukopenia.”

I balked at seeing leukemia on there. The equation became:

Low white blood cell count + bone marrow biopsy = leukemia

It’s a silly thought, considering I haven’t shown any evidence of leukemia and that I deal with a slew of other medical problems that could contribute to the low WBC. (Dr. Hematologist, for one, discovered that lamotrigine – and not venlafaxine, as I’d originally suspected – can contribute to a low WBC.)

Now, I’ve got bone marrow biopsies and leukemia in the back of mind while trying to reassure myself that I’m just an average African-American within the normal African-American WBC range.

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2 Comments

  1. February 6, 2007 at 7:21 pm

    I’m sure everything is okay, if there was a concern I think that your doctor’s know enough not to gloss it over for you.

  2. Stephany said,

    February 7, 2007 at 1:35 pm

    Did you know low wbc and leukopenia can be side effects of certain psych meds? I may have skimmed this post too quickly, or maybe you wrote somewhere else that this has been checked out (meds).The reason this caught my attention, is that a family member of mine using Clozaril has a bi-monthly mandatory CBC, watching for low white blood cell count: leukopenia as a major side effect. So much so, that by law the person has to have bloodwork done or they can’t get their Clozaril.
    Just something to think about if medication hasn’t been regarded in the low WBC discussion.
    Take care.
    stephany


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