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Pathology/Low platelet count, low WBC, low lymphocytes


QUESTION: I did a routine blood test on November 6th (first in 30 years).

White Blood Count: 3.7 (normal: 4.0 - 10.0)
Red Blood Count: 4.8 (normal: 4.2 - 5.7)
Platelets: 63 (normal: 140 - 500)
Lymphocytes: 1.2 (normal: 1.0 - 4.0)

My blood count was low and I have been referred to a hematologist with an appointment on January 5th. I did a follow up test on December 17th since my test with the hematologist wasn't for some time.

White Blood Count: 3.5 (normal: 4.0 - 10.0)
Red Blood Count: 4.7 (normal: 4.2 - 5.7)
Platelets: 66 (normal: 140 - 500)
Lymphocytes: 0.9 (normal: 1.0 - 4.0)

Platelets went up a little but WBC and RBC dropped. Lymphocytes dropped 25% over the course of 31 days and were now below the normal range, albeit borderline. I stopped taking Echinacea as I read that it lower platelet count (a side effect of a stronger immune system). I was previously taking it daily as a preventative measure (but I have read that this is not advised anyway).

I hadn't done a blood test since my family doctor retired 30 years ago, so I don't have any kind of past benchmark. All I know is my WBC is low (and dropping), my lymphocytes dropped significantly and are now below normal, and my platelet count is very low. I don't feel any symptoms other than fatigue, but I am a first time father with a one year old baby that sleeps in our bed at night, so I attributed it mostly to that. Also, I often have difficulty falling asleep (and back asleep) and my sleep is often very disturbed at night with nightmares and strange things that jolt me awake.

One of the things that I read that can cause a low white blood cell count (and low platelet count) is lymphoma that has spread to the bone marrow and of course I am terrified. I am 44 and my first child just celebrated his one year birthday.

I have a small soft lump (like a flattened olive) on the back of my head, just right of the center/spine about an inch above the hairline lined up roughly with my ear. Not painful or growing in size. When I had it looked at, the assumption was that it was a lipoma (or similar harmless mass) as I had gone from 170 pounds to 205 pounds over a 4 year period. I notice there are "occipital nodes" located in the same general vicinity however no one ever mentioned that possibility. I am hoping that this is not a swollen occipital node as I have had it 3 or 4 years now! I don't have dandruff but if I rub my finger against my scalp, it feels as though a little piece (like a grain of sand) can be dislodged each time and I always thought this was a little strange. I read that scalp psoriasis may overwhelm the occipital node... There's no visible rash or dryness at any of the edges of my scalp where the hair stops.

Also, I noticed a little cylindrical mass where my lower back meets my obliques (my side) about inch above my waist. I just assumed this was another small lipoma. It feels as though it's 1 cm long and maybe 1/4 cm in diameter. But I notice there is something called a lumbar lymph note located in that general vicinity...

I also have what I assumed was a lingual varice on the underside of my tongue (the vein kind of bubbles out when I lift my tongue to look at the underside). I know there are submental lymph nodes in the floor of the mouth and submandibular lymph nodes in the anterior tongue. But this is more where the salivary gland is. My dentist wasn't worried, but referred me to an oral surgeon but I have not yet been.

I had an inguinal hernia operation back in 2000. I had an olive sized protrusion that would stick out when I leaned backwards a bit while standing and assumed it was a hernia. I saw a surgeon and he operated on it. Now I see there are illiac lymph nodes in this region and am wondering if it could have been a swollen iliac lymph node instead? Sorry to sound paranoid...

Lastly, I have a rash around my knee that worsens whenever I have sugar. I had something similar a year or two ago in the groin around and on my bum. I thought it was jock itch or candida. I applied different powders and lotions and after several months it disappeared after really cutting down on sugar. I was drinking many high sugar energy drinks at the time. It popped up again on the inner thigh area a few months later and again, after a while went away after greatly reducing the sugar in my tea. It came back a few months ago on my knee and elbow. Now I have it mainly on my right knee (the front not the underside). By REALLY cutting down on sugar it starts to go away (but comes back immmedately if I each too much sugar)...

I apologize for throwing so much information at you!!! But I thought it might be helpful to paint a complete picture. I realize that only a hematologist can truly answer some questions, but I was hoping maybe there was SOMETHING that you could add.

Thank you, and god bless for helping a stranger.

ANSWER: Hello Ken:

Thanks for providing detailed history of your signs and symptoms.

The total White blood cell count (WBC) is low for you in both instances. One possibility is that your normal is outside the usual normal range. These ranges are derived as an average of blood counts taken from a set of healthy individuals. There are always people who may fall outside the range. If there are no associated symptoms then the low count is not of concern. However in your case it is best to have it evaluated by a hematologist, who may advise a bone marrow aspirate examination.

The "lump" on the nape of your neck is most likely lipoma. Lymphoma would progress rapidly and will not stay static for 3 years. The lymphocyte count is minimally low and I think there are no atypical or abnormal lymphocytes mentioned. This again is a good sign.

Platelet count was definitely very low on Nov 6, and them jumped to normal within a month. Echinacea can cause low platelet count, however that happens when taken in combination with certain medication like that for cancer. It is likely there was some issue with blood collection in the first sample which led to spurious low count.

My advise is to follow up with a hematologist, who will ask for a complete set of blood tests and evaluate you properly.

Echinacea is also know to cause redness, itchiness and skin rash.
Please do not worry about the blood vessel in your mouth. Surgeons and other doctors know how to differentiate between a hernia and a iliac lymph node. Please do not worry about this issue. The surgeon likely repaired your hernia. Any minor infection in groin area, lower limbs etc can lead to enlarged lymph nodes in inguinal / iliac region.

Online websites give a lot of information, but for most people without medical background, it has hard to say what information i valid and which one is incorrect. Also some of these can be taken out of context. Please do not worry unduly, visit a hematologist and go from there.

Good luck and Good health to you.

---------- FOLLOW-UP ----------

QUESTION: Thank you Doctor Dahiya,

"Platelet count was definitely very low on Nov 6, and them jumped to normal within a month. It is likely there was some issue with blood collection in the first sample which led to spurious low count."

My platelet level increased from 63 (November 6th) to 66 (December 17th). I think you misread the line for the platelet count for the second test. I had made big changes to my diet (adding more fruits and vegetables and freshly squeezed vegetable juices). Also, there are some supplements that I stopped taking or scaled back on (because I read they could have an slightly adverse affect on platelets). Echinacea: stopped, MSM/Chondroitin/Glucosamine: cut from one a day to twice a week, Celadrin: cut from one a day to twice a week, Omega 3: cut from one a day to twice a week.

The primary issue is finding the cause for the low platelets. My doctor said it could just be ITP or an auto-immune disorder and that was reassuring. But, then I did do an avalanche of research. Some of the causes for low platelets (and possibly also low white blood cell counts) with normal red blood cell counts were Lymphoma and Myelodysplasia. There was also ITP, Lupus, and bacterial blood infections, but that was pretty much it. Some others like Multiple Myeloma and Leukemia I have been told by another online hematologist are very unlikely (Leukemia typically shows high white blood cell counts, though I have read that it can be accompanied by low white blood cell counts too).

So THEN I looked at the commonality of the diseases to see the likelihood it was just ITP causing the low platelet count:

Lymphoma: 14 in 100,000
ITP: 3 in 100,000
Myelodysplasia (MDS): 5 in 100,000
Lupus: 2 in 100,000 males

I couldn't find a way to assess how common a bacterial blood infection was. But just looking at the four above, from a mathematical point of view, ITP and Lupus would account for just 5/24 cases so naturally I was quite concerned.

And one other thing I forgot to mention in my first message. I have a small soft rubbery mass (slightly smaller than a grape) near my elbow on the inside of my left arm just to the right of the elbow. When I first noticed it I didn't make much of it (99% of people would probably not even notice it if they had it). It's about five time the size (give or take) of the corresponding fleshy area on my right elbow. I figured it was from leaning my left arm on my armrest at my computer all day (like an internal callous or muscle buildup). However when researching lymphoma I noticed there are that exact location corresponds to the supratrochlear (or epitrochlear) lymph nodes. When I pinch the mass (to measure the size/texture) the area gets a bit tingly as well as my entire forearm if I do it too much. It also seems to be stuck/connected to the bone as if it being connected by a root. Another online hematologist that has helped me said it could be a viral lymphadenopathy, neurofibroma, lymphnode enlargement due to lymphoma or other mass. He recommended a biopsy of the mass and said that the hematologist may recommend a bone marrow examination. I have to admit, I am very squeamish and I have heard that a bone marrow may be painful. I have read that there are some blood tests that can be done first before considering bone marrow examination (anti-platelets something like that) are you familiar with that?

Thank you again for your help!


Yes I misread the second platelet count. I apologize. Something is causing the platelet to be low. Instead of speculating and worrying, the best course of action is to meet with a hematologist for a complete physical and lab work up to arrive at a diagnosis.


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Neha Dahiya MD


Help patients understand the medical terminology of their lab results and / or tissue biopsy reports.


I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory in India.

Indian association of pathologists and microbiologists.
International Academy of Cytology
International association of Pathologists - Indian division
Indian association of Cytology

MD (pathology) MBA

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