Low White Blood Count

[Cathlo]

Just had a blood test after 3 months on mino. My iron is low (it was before, though now a bit lower), and my white cell count is very low (again it was low before mino – but lower now). Any infection and i have to go straight to doc, or even A&E if outside doc hours. Frustrating. The GP doc knows nothing about mino, and i worry he will want me off it. I see my AP doc tomorrow, so may learn more. Other than a mild headache for last two weeks – which is unusual as never usually have them – i feel fine.

I don’t take any other medications just mino MWF. Am careful with diet – eat loads of greens & orange veg – and for last four months – no dairy, gluten, sugar, hardly any meat, just occasional fish. If i break the diet – as happens most weekends – i suffer with more aches.

Googling it suggests that low wbc is just another joyous symptom of RA – is this the case? Anyone else here similarly lacking in the wbc department? Or know any causes?

Thanks

2013 Poor gut & low white blood cells. Jan 2014 RA symptoms. Diet - no gluten/dairy/nightshades/sugar. Started AP in Oct 2014. On Mino MTWTF. RA improved but still there. Many supplements.

[Maz]

@Cathlo wrote:

Just had a blood test after 3 months on mino. My iron is low (it was before, though now a bit lower), and my white cell count is very low (again it was low before mino – but lower now). Any infection and i have to go straight to doc, or even A&E if outside doc hours. Frustrating. The GP doc knows nothing about mino, and i worry he will want me off it. I see my AP doc tomorrow, so may learn more. Other than a mild headache for last two weeks – which is unusual as never usually have them – i feel fine.

I don’t take any other medications just mino MWF. Am careful with diet – eat loads of greens & orange veg – and for last four months – no dairy, gluten, sugar, hardly any meat, just occasional fish. If i break the diet – as happens most weekends – i suffer with more aches.

Googling it suggests that low wbc is just another joyous symptom of RA – is this the case? Anyone else here similarly lacking in the wbc department? Or know any causes?

Thanks

Hi Cathlo,

Leukopenia can occur with certain medications for RA that suppress bone marrow function, such as Arava or anti-TNF medications (e.g. Humira or Enbrel) and chemotherapeutics (e.g. methotrexate). I don’t think you’ve been on those, have you? In some rare incidences, minocycline can also cause leukopenia. There can be many reasons for low WBC, though, so it’s quite important to know what is causing it, if not medications (and, if not incidental to RA, which Brown believed was caused by chronic infections). For instance, some infections can cause low WBC, because they are immunosuppressive, like some viruses, Lyme disease, rickettsial infections, erhlichiosis (a tickborne coinfection that is prevalent in UK), etc. Wikipedia has some info on this, though you may already have found this link:

http://en.wikipedia.org/wiki/Leukopenia

http://www.cureresearch.com/e/ehrlichiosis/stats-country_printer.htm

As you’ve only been on mino for a month or two, it’s a little doubtful that it’s causing the leukopenia, especially as you had a low WBC prior to starting it. It’s possible it’s exacerbating it, but we’re just fellow patients here and so further testing to get to the bottom of it would be needed.

Do you know what pattern your ANA was showing up when you had it run? Also, what type of psoriasis have you been diagnosed with?

According to the rheumatic.org site, there is a carbon test that can be run to help determine the cause of leukopenia (see FAQ # 14)

http://rheumatic.org/faq.htm

http://bodybio-wellness.com/contactbodybio.html

Hope you find your answers, Cathlo. It may be necessary to take bloods while on mino, then stop it for a month or so to re-run labs to see if it may be worsening things for you, but it’s also interesting to note that pre-existing signs/symptoms can also worsen in the herxheimer stages, so labs can and do worsen initially once treatment begins. Would say it’s important to keep a close watch, though, because none of us are docs here and whatever is causing your low WBC could put you at risk for acute infections (as I think you already said).

Hopefully Dr. E. is on this for you and will run further testing to help get to the bottom of this. If you’re worried about the mino, you could ask to try a different abx (e.g. doxycycline or a macrolide) for a while, too.

[Amelia]

Hello, Catho – how low is your white cell count? My son’s white cell count is always low – he ranges from 3.5-4.1 and we have come to realize that is his normal. My dad’s count also tends to run low. I was alarmed with his white cell count but after 4 years of blood work every 3-6 months we now realize this is his norm.
I admire that you are paying attention to your blood work and asking questions.

[Cathlo]

My white count is 2.4, and neutrophils at 0.8 – which is the bit that tips me into neutropenia.

Saw my AP doc today – DR E in the UK – he was more concerned about my too-low haemoglobin than the wbc – neither is right, but he hopes that if we sort the bigger picture – sort infection – then blood counts will come back to better levels. He has upped my mino to 5x a week @ 100mg to give a bit more of a blast.

Maz – thanks for all that info – very useful. No I am not/haven’t been on any strong medication. And my wbc has been low-ish for a year (before onset RA symptoms) just not this low. So pretty sure it is not the mino causing it. That carbon test sounds interesting – though as Doc said rather than looking for individual cause, we know there is an immune problem/infection – and that is what we need to work on.

I think my ANA was speckled – it was a mild positive. Psorasis is plaque but really so mild not an issue – though interestingly I did a two week elimination diet recently and it cleared completely. Food intolerances seem to play a big part for me – and am quite strict on diet – luckily I am still incredibly tolerant of red vino 😉

Other good news in blood test was RF down from 30 to 21. While Dr Google (always dangerous 🙂 ) tells me it can fluctuate and means nothing, the AP Dr E said it was good news 😀

2013 Poor gut & low white blood cells. Jan 2014 RA symptoms. Diet - no gluten/dairy/nightshades/sugar. Started AP in Oct 2014. On Mino MTWTF. RA improved but still there. Many supplements.

[Suzanne]

Low white blood cell count can also be transient and can mean you a fighting a virus. My daughter’s was low once and returned to normal when they rechecked in a month. Mine was recently low at my annual physical, but was normal when they rechecked it a month later.

Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.

[Maz]

@Cathlo wrote:

My white count is 2.4, and neutrophils at 0.8 – which is the bit that tips me into neutropenia.

Saw my AP doc today – DR E in the UK – he was more concerned about my too-low haemoglobin than the wbc – neither is right, but he hopes that if we sort the bigger picture – sort infection – then blood counts will come back to better levels. He has upped my mino to 5x a week @ 100mg to give a bit more of a blast.

Sounds very sensible, especially if he’s watching you closely. With the low hemoglobin, just be sure to keep an eye on that one, too. Some pain meds can cause stomach ulcers and there are other causes for blood-loss, too.

Maz – thanks for all that info – very useful. No I am not/haven’t been on any strong medication. And my wbc has been low-ish for a year (before onset RA symptoms) just not this low. So pretty sure it is not the mino causing it. That carbon test sounds interesting – though as Doc said rather than looking for individual cause, we know there is an immune problem/infection – and that is what we need to work on.

Yes, certainly sounds like there is something else causing this blood anomaly, especially as it was pre-existing. Might be worth trying to connect with that lab to ask about whether the carbon test makes sense for you. Not sure if there is a similar test in UK or not or if this is a specialty test.

I think my ANA was speckled – it was a mild positive. Psorasis is plaque but really so mild not an issue – though interestingly I did a two week elimination diet recently and it cleared completely. Food intolerances seem to play a big part for me – and am quite strict on diet – luckily I am still incredibly tolerant of red vino 😉

A speckled ANA is indicative of a “mixed connective tissue disease” presentation, which usually means one is disposed to overlaps with other AI diseases…e.g. RA, lupus, Sjogren’s. Did anyone ever test you further to look for lupus with the anti-dsDNA (anti double-stranded DNA) test? The reason I asked about your ANA is because lupus can also present with leukopenia. In the grand scheme of things, Brown didn’t think it mattered whether or not a person had one rheumatic disease or another. He felt they all had a prime cause (chronic infections). You’re tolerating minocycline well, so far, and many experienced AP docs are using minocycline for lupus here in the US. Could what you thought was plaque psoriasis be a form of lupus with skin manifestations (e.g. discoid lupus)? Just a thought to ponder and discuss with Dr. E. or your GP/rheumy, as perhaps it might be worth doing further labs to look for signs that may (or may not) clear up a few of these questions for you…especially if further tests were never run. The testing for seropositive rheumatic disease is a kind of two-tiered testing method, whereby if the ANA is positive, showing a particular pattern, this can point to further testing to check for a specific disease(s).

Other good news in blood test was RF down from 30 to 21. While Dr Google (always dangerous 🙂 ) tells me it can fluctuate and means nothing, the AP Dr E said it was good news 😀

Your RF has never been much out of range….bearing in mind that some here have reported an RF in the mid-hundreds (500+) and one or two folks have even in the thousands. RF can be elevated just from a passing infection or simply as we age. An RF of 30 could mean mild RA, but also could be just an anomaly. In other words, if you do have MCTD, then it’s possible that if you did find you have lupus, it’s possible that it could be more obvious in a person’s overall presentation with an overlap of mild RA. I’ve had the drug-induced variety of lupus alongside highly seropositive RA and it’s very hard to discern the difference in how pain manifests in both these diseases. I.e., when I got drug-induced lupus, I initially just thought my RA was flaring.

Hope nothing here concerns, you, Cathlo, as these are just passing thoughts from a fellow patient and things you might like to discuss with Dr. E. next time. 😉

[Anonymous]

Cathlo,
I always have a headache when my iron is low. Have you ever checked your Vit. B12?
Linda L.

[Cathlo]

Maz, thanks so much – very helpful. I have emailed the BodyBio people to see what they reckon. And if I follow up will post results.

Re anemia – i had a recent stool test and no blood in that. stool test because i’ve had two different parasites – prob picked up swimming in the River Thames – don’t ever do it 🙁 so far docs only got rid of one parasite. so there is one left, but Dr E didn’t think it would effect blood count. I do my best to avoid pain killing drugs, for sake of stomach. take large quantities of ginger and tumeric (reckon i am orange on the inside 😛 ).

Re lupus – interesting. though i don’t have a rash. Having said my psorasis was plaque, having just googled it, i reckon it is guttate – i just have a few dots (nothing like a rash). Doctors have always diagnosed as psorasis (came on at 17 when stressed and studying for A levels.)

“For instance, some infections can cause low WBC, because they are immunosuppressive, like some viruses, Lyme disease, rickettsial infections, erhlichiosis (a tickborne coinfection that is prevalent in UK), ” “discuss with Dr. E. or your GP/rheumy, as perhaps it might be worth doing further labs to look for signs that may (or may not) clear up a few of these questions for you…especially if further tests were never run. The testing for seropositive rheumatic disease is a kind of two-tiered testing method, whereby if the ANA is positive, showing a particular pattern, this can point to further testing to check for a specific disease(s).”
Makes a lot of sense what you say to get further testing – as while i say RA, no-one has diagnosed me fully – I will talk to Dr E but he is not a rheumatologist. He is an allergy doctor and i may be wrong, but i think better on the holisitc approach rather than autoimmune testing. The NHS aren’t very interested in details as such. It is not easy in the UK – would love to know if any fellow UK-ers know where to go????

Re vit B12 – all is good, so is vit D.

2013 Poor gut & low white blood cells. Jan 2014 RA symptoms. Diet - no gluten/dairy/nightshades/sugar. Started AP in Oct 2014. On Mino MTWTF. RA improved but still there. Many supplements.

[lemons]

Hello Cath at http://www.privatebloodtests.co.uk you will find Spire Healthcare. You can choose what test you require at a hospital nearest to you and book it online. You don’t need a doctors referral and the prices aren’t too horrendous.

[cavalier]

I e had persistent low WBC for yrs yes I have Lyme Scleroderma but I finally have brought mine up to a low normal which is huge for me after 4 months of increasing Zinc. Many of us have HPU or KPU read Dr Ks info the LKMD from Seattle. It’s been really great for me to finally see a 4.2 when I was 2.9 forever! The amount of zinc I take is 150 mgs and then another 15 mgs in my multi.

I do add in a bit of copper to balance this of 4 mgs.

Jill

[Author]

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