Persistent immature grans/left shift on CBCs

Posted by lydaneedsadvice @lydaneedsadvice, Mon, Jun 10 3:50pm

Hello,

My name is Lyda, and I've been trying to wrap my head around my recent CBCs that appear to have the presence of what they are calling a "left shift" / immature granulocytes. So CBC on Oct 2018 I had .10 / left shift. However CBC in Dec 2018 showed .05. Than Jan 2019 its back to .10 and March 2019 it is .11 My hematologist is "monitoring" these instances and I am slated for another CBC June 28, 2019.

I do have a couple of known diseases:
Thalassemia [D56.9]
Thrombocythemia (CMS-HCC) [D47.3]
Hypergammaglobulinemia [D89.2]
Hashimoto's disease [E06.3]
Mediastinal cyst (most likely benign from PET/CT scan done Feb 2019)

Both my PCP and my Blood Doctor aren't giving me too much information about these immature granulocytes and or why I am persistently having them. I did do a little research online and couldn't really find anything that stood out other than a severe infection. If anyone has any additional insight I'd love to hear it! Thank you.

Liked by ckeys

Are you taking steroids or have inflammatory processes? Either could effect the creation of extra immature granulocytes. I assume you’re not pregnant as that would be other cause. If you are concerned about cancer, there are other blood tests they could run, as well as order a PET scan. Do you have other symptoms like pain or fatigue? It may be just because you have hypergammulobulemia…so your body is just producing more granulocytes which means there would be more immature ones…that is what left shift means. The addition of off platelet counts could indicate something is off in your bone marrow though, a bone marrow aspiration may tell you more. Good luck!

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@ckeys

Are you taking steroids or have inflammatory processes? Either could effect the creation of extra immature granulocytes. I assume you’re not pregnant as that would be other cause. If you are concerned about cancer, there are other blood tests they could run, as well as order a PET scan. Do you have other symptoms like pain or fatigue? It may be just because you have hypergammulobulemia…so your body is just producing more granulocytes which means there would be more immature ones…that is what left shift means. The addition of off platelet counts could indicate something is off in your bone marrow though, a bone marrow aspiration may tell you more. Good luck!

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Hi @ckeys thank you for the response! Greatly appreciate it. I don't take any medication aside from my 65mg iron pills a day. Also you are correct, I am not pregnant 🙂 I am always fatigue but I associate that with my hashimotos. I did have a PET/CT the end of January of this year to see if my Mediastinal cyst was benign or potentially malignant. The cyst came back as most likely benign. But I had a focal and diffuse uptake on my thyroid (did biopsy which came back negative for malignancy but positive for thyroiditis). I also had a diffuse uptake in my bone marrow which said it was suggestive of marrow hyperplasia. My blood doctor said that's from my Thalassemia (shoulder shrug). But yes, my Doctor did also mention that they will consider a bone marrow biopsy should my CBC end of month have no changes in terms of the immature Gran's and platelet counts. So we shall see.

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Does anyone else have any insight? I am getting my next blood drawn next Friday.

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Hello @lydaneedsadvice,

I would like to welcome you to Mayo Connect. I can certainly understand your frustration at not being able to get a clear picture of the problem you are having. It sounds as if you have several different diagnoses. If you are comfortable sharing more, could you share what type of specialists you are seeing? I would think that one of your specialists would be an endocrinologist. Is that so? What other specialists are you seeing?

Many of us on Connect have had to search for answers to unusual medical problems and we know how much effort you have to put into getting answers. I'm glad to see that you are being persistent and proactive in seeking answers to your problems. This may take a while.

I would like to share with you a post created a while back on Connect. It has to do with how to meet with a new specialist. I think it might be helpful to you in formulating questions for your doctors. Here is the link, https://connect.mayoclinic.org/discussion/your-tips-on-how-to-get-off-to-the-best-start-with-a-new-specialist/?pg=1#comment-240765. I would encourage you to look at items 4 – 6.

Please remember that it is always your right to seek a second opinion. If you decide to get a second opinion I would encourage you to seek out a medical facility with a multi-disciplinary approach, like a university medical school or a facility like Mayo. Do you live near either?

I would also like to tag @JustinMcClanahan to this discussion to see if he might have some insight.

Liked by lydaneedsadvice

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@hopeful33250

Hello @lydaneedsadvice,

I would like to welcome you to Mayo Connect. I can certainly understand your frustration at not being able to get a clear picture of the problem you are having. It sounds as if you have several different diagnoses. If you are comfortable sharing more, could you share what type of specialists you are seeing? I would think that one of your specialists would be an endocrinologist. Is that so? What other specialists are you seeing?

Many of us on Connect have had to search for answers to unusual medical problems and we know how much effort you have to put into getting answers. I'm glad to see that you are being persistent and proactive in seeking answers to your problems. This may take a while.

I would like to share with you a post created a while back on Connect. It has to do with how to meet with a new specialist. I think it might be helpful to you in formulating questions for your doctors. Here is the link, https://connect.mayoclinic.org/discussion/your-tips-on-how-to-get-off-to-the-best-start-with-a-new-specialist/?pg=1#comment-240765. I would encourage you to look at items 4 – 6.

Please remember that it is always your right to seek a second opinion. If you decide to get a second opinion I would encourage you to seek out a medical facility with a multi-disciplinary approach, like a university medical school or a facility like Mayo. Do you live near either?

I would also like to tag @JustinMcClanahan to this discussion to see if he might have some insight.

Jump to this post

Hello,

Thank you for the information, so for the following known diagnosis:

Thalassemia [D56.9]
Thrombocythemia (CMS-HCC) [D47.3]
Hypergammaglobulinemia [D89.2]
Hashimoto's disease [E06.3]
Mediastinal cyst

I am being closely monitored by a Hematologist and my Primary Care (internal medicine). I am not actively seeing my endocrinologist. It will be up to my PCP to determine if I need to go back to see him.

Thanks!

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@lydaneedsadvice, You mentioned you have your next CBC on June 28th. Hopefully, your hematologist can shed some light on your numbers and the shifting of those numbers. Unfortunately, I am not a medical professional and cannot offer much in the way of details on specific blood draws, but I can try to help you Connect with other members who may have similar diagnoses. Here are some other discussions that you may find interesting, and perhaps helpful in regards to some of your questions:

Autoimmune Diseases > Hashimoto's Thyroiditis and IVIG treatment > https://connect.mayoclinic.org/discussion/hashimotos-thyroiditis-and-ivig-treatment/
Blood Cancers & Disorders > Essential Thrombocythemia > https://connect.mayoclinic.org/discussion/essential-thrombocythemia-1/

@lydaneedsadvice, will you update Connect on how your appointment goes June 28th?

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@JustinMcClanahan

@lydaneedsadvice, You mentioned you have your next CBC on June 28th. Hopefully, your hematologist can shed some light on your numbers and the shifting of those numbers. Unfortunately, I am not a medical professional and cannot offer much in the way of details on specific blood draws, but I can try to help you Connect with other members who may have similar diagnoses. Here are some other discussions that you may find interesting, and perhaps helpful in regards to some of your questions:

Autoimmune Diseases > Hashimoto's Thyroiditis and IVIG treatment > https://connect.mayoclinic.org/discussion/hashimotos-thyroiditis-and-ivig-treatment/
Blood Cancers & Disorders > Essential Thrombocythemia > https://connect.mayoclinic.org/discussion/essential-thrombocythemia-1/

@lydaneedsadvice, will you update Connect on how your appointment goes June 28th?

Jump to this post

@JustinMcClanahan hello! Thank you for reaching out as well. I'm seeing my PCP for our three month check up on 7/5 so I was planning to save time and do my all my blood draw that day 🙂 I will update the findings and results once I get that back in 🙂 I do however know that my Hematologist and his Team are telling me that I may potentially need a Bone Marrow Biopsy should there be no changes in my next blood draw. So I'll keep this discussion updated once I find out. Thank you!

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Attaching my CBCs from late last year to recent (early ones before Oct didn't show immature grans, but had persistent thrombocytosis). I asked my PCP if it's normal to see these immature grans on multiple CBCs and she said, no. However she is deferring to my Hematologist expertise and he is currently on vacation this week. So does anyone else have any ideas? I have had this "left shift" and or the presence of them on my last few CBCs, including the latest one done on 7/5.

OCT18_CBC- Test Details

Shared files

CBC_Lyda (CBC_Lyda.pdf)

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