Vacuolated neutrophils: I'm worried what this means

Posted by pepin @pepin31219, Jan 11 11:04am

I have cryoglobulinemia and mGUS. I have historically had low neutrophils on my complete blood counts but the last one they were undetectable. Upon further testing vacuolated neutrophils were found and after researching it I naturally panicked. Thankfully my doctor called and reassured me that I had no active infection and that my neutrophils had actually spontaneously increased. I’m wondering if anyone else has these invaders in their neutrophils.

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@pepin31219, I'm so glad that you were able to reach your doctor and get reassurance that this was not something to panic about. I wonder if @loribmt @gingerw or @auntieoakley may have experience with vacuolated neutrophils to share with you.

Pepin, did your doctor explain why your lab results showed the presence of bacteria? Or what you should be aware of?

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There is a difference between vacuolated neutrophils from a serious infection, and them being in a blood smear that was left standing before it was tested. I am guessing that this information would explain why my husband had very low neutrophils on one test only to have the next test show a normal count two days later. If there had really been a major bacterial infection of that level, he would have been very, very sick.
Did your doctor give you the all clear? Are you scheduled for a quick follow up bloodwork?

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@colleenyoung

@pepin31219, I'm so glad that you were able to reach your doctor and get reassurance that this was not something to panic about. I wonder if @loribmt @gingerw or @auntieoakley may have experience with vacuolated neutrophils to share with you.

Pepin, did your doctor explain why your lab results showed the presence of bacteria? Or what you should be aware of?

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Vacuolated neutrophils are often indicators of an infection such as sepsis or E Coli. So I’m really happy that @pepin31219 wasn’t having any ongoing infection.
With their notoriously low neutrophil count, no wonder there was panic with finding VNs in blood tests. But there’d also have some indications of an infection by that point.

@pepin31219 A theory is that you were exposed to some bacteria and your immune system, though weak, recognized the bacteria as an invader and launched an attack. That would have further lowered your limited peripheral neutrophil count so that it measured non-detect while whatever neutrophils were available were fighting the bacteria.

The neutrophils would have regenerated by the next blood test as the battle was over. In one of your subsequent blood tests, was there a result for LDH lactose dehydrogenase? It looks for signs of tissue damage in the blood.

LDH is an enzyme found in almost every cell of the body. The enzyme turns sugar into energy. When cells are damaged or destroyed, this enzyme is released into the fluid portion of blood. So the LDH test measures the amount of LDH in the blood which can indicate an ongoing or recent infection.

With your disease though, I’m thinking you’re no stranger to LDH readings in your blood because of ongoing tissue damage. How advanced is your cryoglobulinemia? Are you on strong anti-inflammatory drugs like bortezomib or rituximab?

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Thank you for a thorough explanation. My doctor did tell me, after the follow up labs, that I must have been fighting something. The follow up count was 0.90 while the previous one was a manual count of 0.5. Granulocyte antibody was negative, initial lymphocytes were 89% and follow up was 41.7%. There were no LDH reports on either set of labs.

The MGUS was diagnosed by accident and has advanced very slowly. I would guess I've had it for 15+ years. The cryoglobulinemia was diagnosed 12 or so years ago with no symptoms other than hives when exposed to direct cold. I gradually developed purpura on my ankles but otherwise unremarkable. In 2018 during a very stressful complete renovation of our home things became worse and an ulcer opened on my ankle. I was put on 60mg of prednisone for 3
to 4 months and began to taper. A very slow healing process. I tapered to 4mg and developed another open lesion. Back to 60mg and an extremely slow taper from there. I am presently on 8mg, decreasing 1mg/month. So far so good, until recent labs. I am being watched carefully and hope we can make it to 0 but that may not be the case. I appreciate the input from everyone. It is so helpful. Any more suggestions about cryo treatment? It is so difficult to find information on this.

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