OpenHealth Q&A

Why the Urgent Referral to Internal Medicine and Hematology?

I am a 34-year-old Native American woman weighing 160 pounds. My medical background includes a three-year treatment with a low dose of Ozempic, seven years on Metformin, two months using Lithium, and seven years of Pantoprazole. I have Type 2 Diabetes and Bipolar Disorder, both of which are being managed effectively. Approximately four years ago, during a routine emergency room visit, a complete blood count revealed a white blood cell (WBC) count of 18.4, which was later identified as non-infectious. The internist in the ER recommended an Immunophenotyping test for further evaluation. Subsequently, my general practitioner intended to refer me to a hematologist for interpreting the results. However, upon his retirement, the follow-up fell by the wayside. A year later, while I was on vacation, I received an unexpected phone call from that same internist, inquiring about my well-being. I reassured her but was reminded about the need to consult a hematologist. Unfortunately, with the search for a new general practitioner consuming my attention, I overlooked it once more. Fast forward to my endocrinologist appointment earlier this month, where she reviewed my blood count trends and various scans. She expressed concern over my consistently elevated WBC and platelet counts, which have fluctuated between 10.2 to 18.4 for WBC and 537 to 604 for platelets since 2021. Notably, she observed that my lactate dehydrogenase (LDH) levels were normal, ruling out aggressive blood cancer at this stage. Additionally, my autoimmune markers appeared satisfactory as of 2021. Recently, I have experienced recurrent infections, including shingles in November and pneumonia in March, which my endocrinologist flagged as atypical. This month, I noticed a significant loss of appetite, leading to a 14-pound drop in weight; I only recognized this issue last week. I have been supplementing my diet with nutritional drinks since realizing I had lost weight. Furthermore, I’ve experienced a low-grade fever nearly every evening, varying from 37.8 to 38.4 degrees Celsius, although there are nights without a fever. I've had intermittent mild night sweats for about a year. My fatigue has increased substantially, which I initially attributed to the stress of completing my graduate studies, but it escalated to the point where I found it difficult to walk down stairs recently. For the past four years, I’ve also had a resting heart rate exceeding 100 bpm without an apparent cause, alongside enlarged tonsils, though I experience no pain or infection. Upon being unable to descend stairs one day, I visited the ER, shared my symptoms, and received a rapid referral to a specialized stabilization clinic, which includes both Internal Medicine and Hematology. As my appointment approaches, I am eager to prepare thoroughly and would appreciate any suggestions on what documents or information would aid my assessment. My partner will accompany me to the appointment as well. I’m also curious about the Immunophenotyping test performed in July 2021. The results from the flow cytometry analysis indicated the following: - CD3+ CD4+ cells: 51 per 100 cells - CD4 cells: High at 2350 - CD8 cells per 100 cells: 27 - CD8 cells: High at 1240 - CD4/CD8 cell ratio: 1.89, with 10% of cells co-expressing both CD4 and CD8. I’m left wondering what the specialists might be looking for with these results. Although the exclusion of aggressive blood cancer offers some reassurance, I want to be prepared for various outcomes. My recent tests for HIV, Epstein-Barr Virus, and thyroid issues have all returned negative as well. Thanks for your support!

Answers (1)

6/30/2025, 7:10:49 PM

OpenHealth AI

It sounds like you've been through quite a lot lately, and it’s understandable to feel anxious about your upcoming appointment with the specialists. Your elevated white blood cell count, recurrent infections, weight loss, and other symptoms are important factors that the hematology and internal medicine specialists will want to investigate further.

Main Points:

• Your symptoms and blood counts are concerning and warrant specialized assessment.
• Preparation for your appointment can help ensure a thorough evaluation of your health concerns.
• The goal of your upcoming appointment is to identify any underlying issues contributing to your elevated blood counts and other symptoms.

Explanation:

The specialists are likely interested in understanding why your white blood cell and platelet counts are persistently high, given that these could indicate a range of conditions, from benign to more serious issues. Conditions such as chronic inflammation, an autoimmune disorder, or potential blood disorders could be on their radar. Your symptoms, including recurrent infections and elevated heart rate, provide further context for their evaluation.

Your immunophenotyping results provide insight into your immune system's composition. The high CD4 and CD8 counts, along with the ratio, suggest an immune response that might indicate a reaction to an infection, inflammation, or another underlying condition.

Next Steps:

1. Gather Medical Records: Collect any past medical records, especially:

   • Complete blood counts (CBC) from recent and past tests.
   • Results from any other relevant tests, such as the Immunophenotyping test and previous evaluations for infections or autoimmune markers.

2. Symptom Diary: Write down your recent symptoms in detail, including:

   • Any changes in appetite or weight.
   • Occurrences of fever, night sweats, fatigue, and any other new symptoms.
   • The frequency and nature of infections you've experienced.

3. List Current Medications: Prepare a list of all medications you are currently taking, including dosages and how long you've been on them. This information will be crucial for the specialists to understand potential drug interactions or side effects.

4. Questions for Specialists: Prepare a list of questions you have regarding:

   • Possible causes for your elevated blood counts.
   • Next steps in terms of testing or treatments.
   • How they plan to address your recent symptoms and what signs of complications to watch for.

5. Bring Support: Having your partner with you can provide emotional support and help you remember the conversation during the appointment.

By organizing this information, you can facilitate a productive discussion with the specialists and help them better understand your health concerns. This preparation can also alleviate some of your anxiety about the upcoming appointment. Remember, it’s alright to ask for clarification on anything that is discussed during your visit. Wishing you the best of luck with your consultation!