Ask the Lab Scientist Q2 2019

Questions submitted by readers and answered by the CLL Society Medical Advisory Board

By Susan Leclair, PhD, CLS (NCA)

Can a person with CLL be an organ donor?

Answer from Dr. Leclair:  Sadly no. The thought is that a disease which can be found in the blood stream and lymphatic system cannot be guaranteed to be free of all disease. The recipient is at a stage in their deteriorating process to not be able to withstand any stress from the donated organ.

 

All my blood counts are in 100% normal range during treatment; however, in my last test my nucleated RBC was 0.8. This was in the particular labs range. However, it  seems like a strange reading, especially when hemoglobin and all red counts are normal. Any thoughts?

Answer from Dr. Leclair:  One of the possible consequences of all bone marrow related malignancies is damage to the structure of the marrow itself. The marrow has “openings” that allow mature cells to leave the marrow and do not allow the immature cells to cross into the peripheral blood stream. If this damage is present, then it is possible for immature red cells (only immature red cells still have nuclei) to enter into the blood.

 

My WBC count has been as high as 600,000. Why does my blood test give a false positive potassium reading?

Answer from Dr. Leclair:  The general rule is that you need sodium in your fluids and potassium in your cells. When cells rupture, as fragile CLL cells will, their internal potassium is released into the blood stream. Now, if your white cell count is 5.0, that increase is negligible. But, if you have a count as high as yours, then that added potassium will cause the increase in the serum potassium level.  By the way, highly increased platelets and significant hemolysis will do the same thing.

 

My flow test results are as follows: B-cells are composed of entirely of a monoclonal population with the following phenotype: dim CD5, CD 19, dim CD20, CD 23 dim kappa surface light chain, 51% lymphocytes, 0% B cells and 3% T cells, 4 NK cells Kappa/lamba monoclonal, and CD4/CD8 1.7.1. Small lymphocytic lymphoma; minimal peripheral blood involvement by mantle cell lymphoma is also possible. What does this all mean.

Answer from Dr. Leclair:  First, in general, lymphocytes should have a wide variety of markers on their surface as you want them to be capable of responding to a wide variety of stimuli. If a healthy immune system meets up with some type of challenge, then there should be a slight increase in the number of similar cells as you grow a population of lymphocytes to combat that organism or stimulus. Then, after the challenge is successfully removed, those cells should die off. Your next flow cytometry would then go back to a wide variety of markers.

In your situation, you have one population of cells. This pattern of markers is consistent with a type of chronic lymphocytic leukemia or mantle cell disease. The difference between the two must be diagnosed by your physician.

 

If LDH rises into the 600s U/L, what should be of concern and tested for to further investigate? Please note, all CBC values are in normal range except ANC 160. Undergoing no treatment and currently in Watch and Wait.

Answer from Dr. Leclair: Using only one value is rather difficult to interpret. The LD is an enzyme that is found in almost every cell in the body. So whenever a cell is damaged or dies, that cell’s enzyme is release into the blood. 

So, have you had trauma, medications, inflammation for any reason, etc? Did you start an exercise program? Are you within 6 months of some immunotherapy program? And so on. All that can be said is that somewhere there are cells being damaged, but not where or why.

 

My lymph is 47 and neut is 41.2, what does it mean?

Answer from Dr. Leclair: This is a common problem with our reporting system. In the older days, microscopic evaluation of white cells was done by an evaluator categorizing the first 100 white cells seen. Since a percentage must always total 100, it did not take into account that some cells tend to cluster together. This is called the percentage count (%).  What it excels at is the assessment of what these cells are reacting to. 

With the advent of sophisticated counting instruments, it is possible to count thousands of cells and provide a much more accurate assessment of the cells present. This is called the absolute count (ABS or #). It is also much easier to understand. What it is not good at is the interpretation of the cells’ quality.

For example, suppose your WBC was          NEUT%        LYMPH%          NEUT#       LYMPH#

                                                  4.0                       41                 47                  1,640          1,880

The reference range for the absolute neutrophils are roughly 2000 – 8000 so this shows a DECREASE in neutrophils not the increase in lymphocytes which the percentage suggested.

                                                   8.0                     41                  47                   3,280          3,760

The reference range for the absolute lymphocytes is roughly 800 – 4600 so this shows that, despite the percentages, these cells are in perfect acceptability.

                                                   11.0                  41                  47                    4,500         5,177

Aha, we finally get to a number that suggests there is an increase in lymphocytes.

So, the bottom line here is to check the absolute values, and if they are not given a close approximation to the values, would be to multiply the total white cell count by the percentage each of these two cell lines and see what you come up.

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Susan Leclair, PhD, CLS (NCA) is Chancellor Projessor Emerita at the University of Massachusetts Dartmouth; Senior Scientist, at Forensic DNA Associates; and Moderator and Speaker, PatientPower.info – an electronic resource for patients and health care providers.