Persistent elevation of absolute immature granulocytes 7 months 0.04

Lab work (CBC-Diff) in oct 2024 and again in May 2025 shows 0.04 elevation in Absolute immature granulocytes. Notes from Lab say "Immature granulocytes are left-shifted granulocytes and do not equal blasts. They are composed of metamyelocytes, myelocytes, and promyelocytes. Their presence can be seen in infection, inflammation, certain medication effects, or other bone marrow stimuli. Occasionally, persistent increase in immature granulocytes may be part of myeloid neoplastic process. Correlation with clinical findings is recommended for complete interpretation of this parameter. Please also note that peripheral blood with immature granulocytes >5% will be manually reviewed by lab personnel and/or pathologists." My Dr says no concerns and dismissed both lab reports and is disinterested in investigating underlying cause. I know it isn't a really high level but have been having some strange symptoms we thought may be cardiac but other symptoms that concern me. Mostly concerned that is has persisted 7 months. Not just worried about worst case scenarios but also at whether we should be looking into possible infection or inflammatory response at the very least. Doesn't seem a good thing to ignore possible persistent infection or inflammation either....is it?

Hi @lightgoddess It’s understandable to be concerned when you’re feeling ‘something isn’t quite right’ and having your doctor be dismissive.
If this were me, I’d be seeking a second opinion. Have you been seen by a hematologist?

Not yet....wasn't sure if I needed one. Appointment next month and I will discuss that with PAC (since Dr is on 10 week vacay) and will ask about it. Of course they will want me to wait a few to several months before they will actually give me a referral. Only ever asked for 2 referrals from them. One for Physical Therapy per surgeon's instructions (they told me that would take 6 months). Cardiac symptoms also since February along with BP and HR readings all over the place and told at LEAST 3 months to see Cardiologist. I wonder if I can get into seeing a Hematologist w/o primary care referral? Not really confident in my UHC provider network atm and not sure where to go from here. I don't want to over react but this has been an issue since last October and if an issue AND persistent as well then I don't know if I should just sit back and ignore this. I only found the results by accident. No one said a word to me about it though both tests are in their records for me.

Good morning, @lightgoddess. It sounds like you have a number of symptoms that you and your doctors are investigating. The blood test results showing immature granulocytes (IG) was just part of their sleuthing.

There can be a number of reasons for the elevation of IG in the blood as part of an immune response to inflammation or other conditons. Some reactions can be just the body’s normal response to things such as pregnancy, infections, auto-immune diseases to more serious conditions like bone marrow disorders with the inclusion of blast cells.
However, your test showed there were no blast cells, which is good.
The wording on your results regarding IG: “Their presence can be seen in infection, inflammation, certain medication effects, or other bone marrow stimuli.” “ Correlation with clinical findings is recommended for complete interpretation of this parameter.”

Considering you have some other health issues going on right now, (and no blast cells) your doctors are taking the results at face value; That the IG elevation is due to inflammation from your current health situation and not necessarily concerning. So you most likely don’t need an evaluation from a hematologist at this time.

You mentioned having surgery and undergoing physcial therapy. Physical stress or events like surgery, trauma, or severe illness can push the bone marrow to release immature granulocytes into the blood.

I can feel your frustration for having to wait for PT and a cardiology appointment. Usually with any type of surgery, if there’s PT recommended for recovery, it’s right away, not 6 months later. Are you in an area with limited practitioners?

You need a referral. Sometimes the ER doc can put one in.. referrals are needed to get into hematology. My guess is it may not be that bad. Once you get into hematology, who knows what they may do. Have you researched any medications you may be on? Diet? Hope you find you answer...

Thank you! Yes, I have researched the meds I am on and shouldn't be that.

Thank you so much! Since cause could be persistent inflammation or infection that has gone on for 7 months, shouldn't they be investigating and possibly treating those potential underlying issues? The physical therapy was for a complicated break of lower leg bones and cartilage at the ankle. Orthopedic surgery and hardware. Over 7 months ago. Minor swelling from time to time still but not significant inflammation for the past several weeks. I would think that as the cause but the first abnormal blood test was in ER within an hour or so after the injury. Is it likely that the trauma would almost immediately after the injury elevate the levels in blood work? Is it likely to persist at same levels despite the fact that the inflammation from the injury/surgery has decreased from severe and persistent to very mild and intermittent.

I am in Spokane WA....good medical centers and such here. One of the main hubs for the inland NW states. My network isn't the greatest though....it is Multicare contracted with UHC. Mostly just PACs (which they can be great but ALOT of them very young and inexperienced) and few actual Drs.

For context: As for the other health issues/symptoms which started in January. Intermittent bouts of nausea, dizziness, fainting (once faint and twice near fainting), shortness of breath, dizziness, lightheadedness, fatigue, some surface numbness in the non-injured lower leg and palpitations. Awful family history with 6 heart attacks under age 58. SCD in four of them ages 39-58 (3 of which were in early 40s) and the other 2 had CAD, one death from stroke at 65. I am 61 with heart risk health history and occasional Tachycardia issues...stress related. So on a cardiac patch monitor presently. I don't know if symptoms could be cardiac or related to an underlying condition (infection/inflammation somewhere) or something else entirely causing the elevations like this in the bloodwork. It is all just too weird. Normally I have no notable health issue symptoms and very rarely (once every year or so) even catch a cold. Sometimes I go years w/o seeing a Dr. So, this is rather unsettling for me to have all this going on at once....lol.

Thank you so much for your insight!

Hi, @lightgoddess. With your family history of coronary related deaths and your relatively newly developing symptoms it’s understandable to feel unsettled about your health. I’d be feeling the same way! I know it feels like medicine moves painfully slowly when we just want to know what’s wrong with us!

However, reading through your comments I think there’s already some forward movement since you’re wearing a cardiac monitor and have an appointment to meet with a cardiologist team member next month. Personally, I’d take some comfort in having that appointment in my back pocket. You may find that the cardiologist will order more tests such as imaging and blood work to check for inflammatory markers as part of their workup.

Just for informational purposes, there are some key lab tests which may help to assess inflammation. https://www.rupahealth.com/post/5-lab-tests-that-may-help-assess-inflammation

Have you had any of these tests?

No, They have done no tests whatsoever pertaining to inflammation at any time in the last 15 years though in 2012 I did test elevated for C-reactive proteins on cardiac assessment test. They have done no testing or even discussed the abnormal IG test results when I inquired....just said "of no concern" and that was that. End of subject as far as the PAC was concerned.

I have not yet seen a cardiologist. Appointment is with the Primary care PAC (since Dr is on her Vacation still till August) told me a couple weeks back that it would take at LEAST 3 months before I could get referral thru to see a Cardiologist. The next few appointments only with the PAC. She is the one that dismissed the abnormal blood tests with the elevated IGs when I asked about them too. Frankly, they seem under-concerned about either potential issue. This last one with the blood tests I just found out about by accident, though they have been in my records since October 2024. Who knows how long they will put me off on seeing a hematologist since they dismissed the results out of hand. I doubt she even took any possible overlap on symptoms between the two (and other symptoms like 65 lbs weight loss in months following leg break/recover that they haven't really discussed....maybe partly from better diet but 65lbs weight loss between October-January is still pretty high) under consideration before she dismissed these abnormal test results as nothing concerning.