Firm lymph node + low WBC for 1 year — could it be lymphoma?

Hi @ahmg. It sounds like you have a little mystery going on with the swollen lymph nodes. You’re doing all the right things in having this looked into to see if there’s any reason for concern.

You mentioned having a consistently low white blood count. Do you recall if the blood work you’ve had done was a CBC or was it a CBC with Differential?
The differential will define each of the 5 types of white blood cells. With lower counts, especially neutrophils and lymphocytes, your body will have a more difficult time fighting off infections. It can take some sleuthing to get to the ‘why’ it’s low though. Sometimes it’s an underlying inflammation or fighting an infection. And yes, there can other causes. It’s too premature to jump to lymphoma but it is good to be proactive. You’d like answers so that you can let this go…

Your doctor did check for inflammation with the ESR and viral panels. CRP or C-reactive protein test can be useful too.
Another suggestion is to have a biopsy of the lymph nodes. Do you have swollen nodes anywhere else? Has your doctor suggested a biopsy of the lymph nodes?

> I’ve had multiple CBC with differential tests over the past year. Here’s a summary of the results:

WBC ranged between 2.6 and 6.0 ×10³/μL

In the last 2 detailed tests:
• Absolute Neutrophils: 1665 and 1836 (low)
• Absolute Lymphocytes: 1591 and 1440 (borderline)

In a previous test with WBC = 2.9, there was a generalized decrease across all white cell lines, not just one — which could suggest a systemic or immune-related issue.

Other parameters like hemoglobin, platelets, and ESR have remained within normal ranges.
Viral screening (EBV, CMV, toxoplasmosis) was negative for active infection (IgM negative).

The lymph nodes (firm but painless) are only in the inguinal/pubic region and have been stable in size for about a year.

I haven’t seen a doctor in person in quite a while, which is why no biopsy or imaging was requested yet. I’m trying to gather information to better understand my situation before proceeding.

Would you suggest starting with a CRP test, or go straight to imaging or biopsy

Hi @ahmg, I’m with you on wanting to know as much as possible about what’s going on with my body if something feels amiss. We do have to be our own health advocates because no one knows our bodies like we do! But your symptoms have been causing you a level of concern for a year and it would be huge relief for you to find out definitively if there something more to your symptoms.

So, frankly, instead trying to determine which tests to get first, it’s time to check in with your doctor…either your GP or maybe seek a referral to a hematologist.

Since the swollen lymph nodes and your low wbc seem to be persisting, if this were me, I’d request an appointment with a hematologist. They specialize in blood disorders…not that you have one. But anytime you have blood numbers consistently out of a normal range it’s just good medicine to try and find the cause. Again, it might not be anything more than something like generalized inflammation. But I get the feeling you’d really like to have an answer.

Do you need a referral to a hematologist?

I have done two CRP tests several months apart.
The first one was in September 2024, and the result was 3.8 mg/L.
The second one, done recently, showed a result of 3.15 mg/L.

Both results seem to suggest a low-grade chronic inflammation.
I don’t have any signs of acute infection at the moment.

In addition, I had Toxoplasma testing done twice. Both results showed IgM negative and IgG positive, which indicates a past infection, not an active one.

I also had a full viral panel, which came back normal.

Could this ongoing inflammation be related to my persistently low white blood cell count and the stable lymph nodes I’ve had for over a year?
I’m wondering whether this could be immune-related or worth further investigation with a hematologist.

Hi @ahmg. Yes, having chronic underlying inflammation can be a cause of a low white blood cell counts, which in turn weakens the immune system and your ability to fight infections. Considering you’re 25 and have a long life ahead of you, it might be a good idea to find the underlying cause of this inflammation and why you have these persistent swollen lymph nodes. Having a low WBC isn’t always a sign of a medical problem but it’s good to have it checked out.

Conditions such as an autoimmune disease, low Vit D level, food and mold sensitivities, low hormone levels, yeast infections, lymphoma, leukemia, other blood disorders, etc., can be potential culprits for low WBCs. So it may take some sleuthing.
You could start with your PCP instead of a hematologist to see if there are other blood tests, imaging, perhaps a biopsy of a swollen lymph node to narrow down the cause. If this is related to an autoimmune disease you may be referred to a rheumatologist.
I have the feeling that this is troubling you and you’d like to get to the bottom of the issue. So start with your primary doctor and take it from there. Does this make sense?

Yes it probably is I have beef two years now

Two years