I’m a 68-year-old male with Addison’s disease and hypothyroidism (the skinny old guy with a kazillion questions at the 2020 seminar in San Diego). My blood tests have shown neutropenia for the past 6 years, averaging about 1200 cells/uL; the lowest until recently was 800. Those tests were being done about twice a year.
About 6 weeks ago I had a neutrophil count of 443 on an early morning fasting blood draw. I hadn’t been noticing anything out of the ordinary, aside from a vague feeling of malaise for a few weeks following a cold I had in late January, but my GP was alarmed by the neutrophil count and referred me to a hematologist, who ordered a bone marrow biopsy. The comments on the biopsy say “slightly hypercellular marrow (50-60%) with multilineage hematopoiesis and left shifted erythroid maturation”, “small monoclonal CD5 positive B-cell population”, “this may most likely represent monoclonal B lymphocytosis”.
Since then I had a late afternoon neutrophil count of 1040 on April 2, and an early morning fasting result of 1118 on April 18, so apparently things have been on the upswing. At my post-biopsy followup with the hematologist, he said that he thinks I have cyclic neutropenia, that in his experience people with that do quite well, and that no lifestyle changes are necessary. He ordered another CBC in 2 months, and didn’t mention any treatment.
I’d be delighted if that’s all there is to it, but I can’t help wondering if there’s more to be done - like maybe a series of more frequent CBCs to test for cyclicity (and maybe even be able to predict the low points, if it is cyclic), some kind of followup on the possible lymphocytosis, and/or some kind of treatment like G-CSF. On the other hand I’ve been feeling fine, and am working out as usual (cardio + lifting most days, 90-120 minutes total) with no apparent ill effects, so maybe I should just relax and not try to head down the rabbit hole of excessive testing!
Any thoughts? I understand this may be a bit much for a forum post, and would be fine with scheduling a consultation if that’s more appropriate.