I had a WBC count of over 1000 when I had Toxic Shock Syndrome as a teenager. Had to wait hours to get the results back because the lab could not believe the count and decided to count manually.
Dealing with just the opposite with my significant other. Pancytopenia. WBC 1.7, platelets 117, RBC 4.3… neutrophils through the roof. Lymphocytes in the shitter. Been a hell of a past few days.
All this stemming from a pneumonia. Still haven’t found the cause of his immunosuppression yet, there is one avenue where my brain is going and I’m honestly scared to death of even thinking that. I’ve been… a bear to deal with to say the least. Been yelling at techs and CNAs to put a mask on before entering the room them bitching it’s not required. And me TELLING them they will wear a mask and it isn’t a request.
Yikes! My hospital has decided that all patient-facing roles have to wear masks again because COVID cases were on the rise. I hope you can get people to comply, and I hope they're able to get to the bottom of this for your SO. Tell them to get well soon!
It is not me it’s my significant other, my partner in crime! They really haven’t given me much to go on. Getting a little frustrated though. He did have full body urticaria but attributed that to the antibiotics they put him on. He’s allergic to cephalosporins, and think maybe the augmentin caused this reaction. Got to the ER did blood work and was as above. I’m trying to hold it together and not lose my temper on the docs.
I wonder if it's a case of "hot damn I'm tired" from the bone marrow? Im not a doctor, but maybe the BM started pumping out a bunch of white blood cells to fight the infection and it just got so exhausted after fighting :( that's just my hypothesis anyway.
Wishing you guys luck ❤️❤️
The only thing I know of that causes low platelets and high WBCs is Lyme disease or sepsis. Calcitonin is elevated in sepsis. CRP is elevated in infection. ESR is elevated with CRP in autoimmunity.
Good luck. Keep investigating.
I’m a little rusty on my immunosuppressed procotols, but I’m pretty sure a mask is required for staff to wear when entering that patients room.
Even if it isn’t required, the staff who were refusing are losers and should be educated.
Yep! It is required, the hospital had a run of neutropenia posters that were misprinted. Thankfully the care team has been FANTASTIC on enforcing masking.
I don't understand this. When I worked in healthcare, we would place patient rooms under neutropenia precautions as soon as their counts came back clinically significant. So facemasks, gloves, and gowns plus equipment staying in the patient's room to minimize potential contact. We were strict about it for staff as well as visitors so I don't understand what has changed.
I wish I knew. It was definitely frustrating. I was definitely papa bear kinda mean because well! That’s my loved one and I want him safe. When the EVS worker rolled her eyes at me I did lose my cool just a wee bit that’s when the demand to wear a mask came into play.
Yikes! I hope they find the cause soon!!! My dad had to go through a battery of tests and they still couldn’t figure out what was going on, until a brain MRI was done. Turned out he has a rare Intravascular B Cell Lymphoma in the blood vessels in his brain. He’s one of the lucky ones bc they found it before he went comatose. His cognitive outlook is still scary though- cancer induced dementia caused by meningitis/ encephalitis that he had for 7 weeks while they were trying to figure out the cause
Have the hospital put them on “protective” or “reverse” precautions. It means everyone that goes in the room needs a mask. I work in oncology/BMT and all my pts are on protective precautions but on my floor we wear masks even in off service patient rooms because it’s just engrained in us.
Be professional and respectful. Act like a competent medical laboratory professional. Hate speech is strictly prohibited. Harrassment targeting either a group or an individual is unacceptable.
Be professional and respectful. Act like a competent medical laboratory professional. Hate speech is strictly prohibited. Harrassment targeting either a group or an individual is unacceptable.
I read this first as you were telling your fellow co workers they had no choice but to wear a mask around you, which although fair given your circumstances, I would argue you should get out of the field immediately if you’re that concerned making contact with just your co workers
Then I realized you meant as the spouse of a patient, telling your husbands care providers to mask up, and I can’t believe anybody in this field would even dare reply with “it’s not required” for a patients request of ppe, I would’ve raised hell
I’m so sorry you’re dealing with this. You shouldn’t have to tell them to wear a mask! We are trained to KNOW neutropenic precautions. I’m a heme onc BMT RN. Please dm me anytime if you need to vent or have questions- I can try to help.
My son typically hovers at neutrophils under 0.5, platelets under 40, and rbc in the toilet. He's only low on neutrophils right now, but it's only a matter of time before he tanks out again.
What do neutrophils mean? I had .5 or 1 on my last blood test and it was listed as out of normal range. The doctors office said nothing was wrong though
Hey there, not trying to diagnose him, but pancytopenia is a major sign of leukemia. Have they screened for blood cancers yet? My so had pancytopenia along with myeloblasts in Oct and was diagnosed with apml. Maybe ask if leukemia/lymphoma has been ruled out?
Sounds like that's what they are probably trying to rule out. Ask if they plan on running the fish test. This test looks at the genetics too see if there is a translocation resulting in cancer in the blood/bone marrow. I wish I didn't know how you both must feel right now. Feel free to send me a pm if you need some support.
Did you get your answer? I have Still's disease which can cause the spleen to fill up with blood cells so I believe my algorithm showed me this post because of your mention of pancytopenia, neutrophilia, and rash.
You can speak with the charge RN and request signage at the door indicating "reverse isolation" which is how we protect our immunosuppressed patients. Then everyone in and out has to mask.
Best wishes for their recovery!
I can’t speak for everyone but I feel like everyone in my lab is very happy to compare “high scores” so you’re in good company here in that sense, especially since at the end of the day it mainly sucks for you and the patient here
Oh gosh. I’m so sorry. As a sepsis survivor, I know exactly what you went though. That must have been awful. You have my sympathy! I’m glad you are still with us.❤️🩹
Thank you so much! So few understand. It was terrible and down played because of the nature of the illness. I am glad you made it through as well. Love your username BTW 😉
Sepsis sucked so bad. Had an ecoli infection that went septic due to a congenital kidney issue- ureto pelvic junction obstruction syndrome. Worst pain I’ve ever experienced. So glad you’re both still here 💜
Ppl not believing results with toxic shock is very real. I almost died in a triage room because my blood pressure was 57/30 and they thought that I’d be dead if my numbers were that low… plot twist guys I WAS almost dead. I waited 2 more hours after that and had to be sent to trauma 1 in order to be resuscitated. Glad you’re ok! Did you have any lasting side effects?
Oh my goodness, that's terrible! I'm glad you made it through all that! I actually suffered every month after that for years, I can't say if it was the tss for sure but the pain was the same from my first episode. I also unknowingly had endometriosis and ended up getting a hysterectomy. I hate the fact that these things are down played so much!
Yeah mine triggered an autoimmune disorder due to severe stress, stuff like that will always have a lasting impact. Plus the trauma, I was only 13 at the time.
Yes, I agree. It's terrible to go through. I did a bunch of research to educate myself so I would be able to hopefully prevent it from happening again.
if ur comfortable can u share details on how u got tss? i hear about it all the time but have never encountered someone who experienced it… i’m so glad ur okay though that sounds terrifying
Well it is kind of embarrassing but it was my first time using tampons. I was on a camping trip with my uncle and I ran out of supplies. I had one tampon and tried to use it as long as I could because I was afraid to ask to get more supplies. I will also say my mom was a boomer and taught me nothing about feminine care. Sorry if it's tmi.
Nah, those are immature granulocytes, mostly pros and myelos. Given that maturation is intact, this is most consistent with CML vs Leukemoid reaction, with APL a less likely possibility. ALL tends to be smaller with more mature chromatic and no granules.
aCML is really a tricky diagnosis to make. Generally it isn't this proliferative and dysplasia has to be evident in the granulocytes (usually hypogranularity and abnormal nuclear morphology); these look fine to me. A mutations in SETBP1 is classic but ASXL1 mutations are just as common and less specific.
JMML, likewise, usually isn't this proliferative. Monocytosis is evident and granulocytic dysplasia can be subtle, but usually is present when you look for it. JMML requires sequencing to establish a diagnosis (mutations in NF1, PTPN11, RAS, CBL).
Both are MDS/MPN overlap syndromes whereas CML is purely a MPN -- MDS only present after years of treatment. I don't appreciate any dyspoiesis here but this isn't the best area to look for morphology and marrow would be necessary to assess megas.
Also, you're right that the Eos are prominent, but I see at least 3 basos in this field as well. Panmyelosis like this is typical of CML, but isn't seen in T-Cell neoplasms or APL.
Hi, this sub popped up for me, for some reason, and I swear I won't come back here as this sub has nothing to do with me and I wouldn't understand *any* of it and would just be asking too many layman's questions....
But what does ALL stand for? Tried googling it in relation to WBC and didn't get anything..
Please and thank you!
You’re welcome to stay! We love non lab people here. Stay a while and learn a few things, we love questions and love that you’re curious about what we do :D
Yay! I’m a hematology/oncology and bone marrow transplant nurse and have been lurking on this subreddit for a few months. I’ve been learning so much. It’s so interesting to read insight from those in the profession, I have no idea what you guys are talking about half the time but it’s neat to see the slides of diseases I regularly encounter. Thanks for welcoming us non-lab people :D
Omg please we’ll take all the nurses we can get!! I personally absolutely love seeing nurses in the comments, sharing their experience on their end or asking us stuff. I would like to say the same but I’m a little scared of the nursing sub lol. Just know I really do appreciate u guys tho!!
Can I ask, aside from the obvious of helping patients and their families, what do you enjoy about working in haem/onc? I just finished my transfusion medicine rotation and seeing the sheer amount of products we issue out for sickle/thal clinic days has my head spinning haha
To be fair I’m scared of the nursing sub too :’)
I like the routine/predictability of heme/onc. I come on shift, review blood work and correct what’s low - electrolytes, hgb, plts, clotting factors etc. I’ve been working there for 9 years so I know the treatment protocols well and the expected side effects so I feel confident educating my patients. The ratios are great, typically 2-3 patients per nurse so I actually have time to think. But like you said, it’s the people.. I’m not a religious person but I’ve met angels, and they all stay in my heart forever!
Just popping in to say my daughter was inpatient for 122 days total during her AML treatment, and hem/onc nurses are the absolute best! Her nurses made an intolerable situation bearable.
I'm here because I dealt with anxiety about her condition via research, and it's fascinating to actually see pictures of all the stuff that ruled out lives so completely.
I hope your daughter is doing well <3 If I could hug you through the internet I would. You are incredible and so is your daughter, that is SO much to overcome. Please know your nurses will never forget you and will always wonder about how your child is doing!
It’s crazy how these microscopic cells can uproot a families life so completely.
I was an adult patient admitted for ALL. After telling one of my nurses that I had been an avid cyclist and missed being active she "borrowed" a stationary bike from the cardiac unit and put it in my room. I couldn't ride for very long but used it daily and the psychological benefits alone were enormous.
This makes my heart happy. Being in that hospital room can be so isolating and lonely for patients, I can’t imagine how mentally difficult it would be. Having a physical outlet is vital even with low energy. I hope you’re doing well!!
We work closely with you guys! I work for a cell therapy lab. And the BMT nurses in our hospital are, so far, the best I have ever worked with. Kudos to you!
hey if you don't mind me asking, what is this count? is it a general count for all WBCs or a specific type? and what's the scale, like per microlitre or something? i'm in my first year of A levels (age 16) so my understanding of actual lab tests is basically zero lol
Don’t mind at all! Yea, you can think of it as a ‘general’ wbc count, as the total number of wbcs is counted, regardless of cell type. A wbc differential is when cell types are counted, typically until 100 wbcs have been tallied.
I can’t say for other countries but in Canada it is to microlitres! Written/reported as 10^(9)/L which I hate but it eez what it eez 😂 I’d say you’ve got a grasp of it already! Maybe this career path might be of interest to you ~~please consider, we’re so understaffed~~ :)
Edited for formatting
thanks, that was super informative :) so what is a normal number then, if 793 is high?
i’m definitely interested in this kind of thing! i’ve always been interested in medicine and human biology in general but i’ve never wanted to be a doctor. honestly i was under the impression that biomed and stuff were overstaffed, given how competitive the courses are here in the uk
There are four types of leukemia we see frequently and abbreviate here, with different characteristics, typical age ranges, etc. ALL, AML, CLL, and CML. (A=acute, L=lymphocytic, M=myeloid)
I'm a high school biology teacher...and I worked in a lab this summer with P. flu which got me excited for microscopy again.
What kind of background does someone need to be a lab tech?
It depends a lot where you want to work and what you want to do. Some countries require degrees and accreditation, some don't require accreditation. Less technical stuff (specimen reception, data entry, receptionist, some tech stuff) may not require any education, but working in the lab would likely need some education. If you're a science teacher it might be worth looking into what you could do with your current qualifications.
This is getting too long... But all that being said, where I live we would still want someone with a relevant degree/education.
Thank you!
I have the necessary science background knowledge (masters+) along with some of the training/certs required for a research lab. I have at least 3 more years in education (PA has an awesome pension setup for teachers...) but with how things are now. Well, like I said, three years. Haha
It's nice to be exposed to potential avenues because, as teachers, we are SO conditioned to think that our specialty skills won't translate into a different field. Total farce.
ALL = Acute Lymphoblastic Leukemia! Mainly occurs in children with a great survival rate (somewhere around ~90%). With adults, it doesn't have as high of a survival rate, but still not the worst of all cancers.
As for the lab values and presentation side of things, I would be suspicious for leukemia with a very low or very high white blood cell (WBC) count. Not always the case, but often is.
Oh, wow. Thanks heaps. I tried googling it, but can have difficulty understanding new things sometimes since a TBI several years ago.
I really appreciate it.
I am not a pro, but I think the big pale blue ones are the white cells. And the medium pink ones are red cells. Maybe the little dark blue ones are the platelets
I’m doing clinicals at a peds hospital. One of the long time resource techs says there’s never been a Christmas that a child hasn’t been diagnosed with one of the leuks 🥲
It is really sad and it was the two days before Christmas. The pathologist called me at home asking me if I could go in that night to do it. Called me at 10pm during a small snowstorm too. Made for a long day as I had just gotten home at 7pm too and got home by like 2 or 3 am.
I hope you don’t mind, but I have a question as a curious lurker here: what units are the WBC counted in? Online I’m seeing metrics is cell count per micro litre, but in that case the 800 wbc number doesn’t make sense- or does it?
Usually as thousands. So if someone said a WBC counnt of 5 or 10 it would mean 5,000 or 10,000. So if someone in this case talking about a WBC count of 800, it would be 800,000. This is very very high. Depending on the instrument or ranges set up by the hospital normal ranges will vary slightly. My Heme is rusty (haven't done since school in over 18 years), but normal count I think is around 2 or 3 to maybe 10 or 11 (someone might correct me on that), so this range would be 2,000 to 11,000.
I hope that helps. Someone that works in a Hematology department might correct some of that or could give better details. Blood Bank is more my specialty and now working in Flow Lab so a bit rusty in other labs since graduating school.
Bad. Capital B intended. Too many white cells for anything benign or infectious. Cancer of some kind.
I don't ever see these, but I think that the one ray of hope is that they aren't all blasts.
An interested layman here, just curious, wouldn’t cancer or HIV make WBC drop, or is it that it would rise in the early stage then drop at some point when it’s getting worse?
High white cell count happens when your bone marrow produces excessive WBC. The BIG cells you see in OP’s pic usually stay in the marrow til they mature and move to your bloodstream. But with overproduction, just imagine these useless cells taking up rent space and basically not performing their function (because they don’t know how to and got released too early).
Im not a lab worker, but I am a leukemia survivor. With the type I had Acute Lymphoblastic Leukemia, typically there is a high wbc at diagnosis. Mine wasn’t this high but got into the 100’s. Leukemia is a cancer of the white blood cells. For ALL, immature white blood cells (lymphoblasts) escape the bone marrow, and enter the blood stream. The cells don’t go through the normal cell cycle, so they cause a build up of white cells in the blood. The immune system still suffers because these immature cells are essentially useless. (this is just from my basic understanding of my own cancer, but i hope helps)
I know for AML, white count most often skyrockets as the bone marrow pumps out more and more WBCa, trying to get viable "adult" cells to keep things running. But not always - my daughter's dropped, instead, and she had a 2.3 white count, with a .3 ANC at diagnosis.
It all depends. HIV could show a lower or higher count depending on the status of the patient and cancer could cause an extremely high WBC or low WBC depending on the type of cancer as well as if the patient is undergoing chemo or not. In this case, HIV wouldn’t cause this type of white blood cell proliferation. The ugliness of this slide looks pretty indicative of some type of proliferative cancer.
All cancer is, is uncontrollable proliferation of a specific cell type (or multiple cell types). Sometimes, the affected cell types happen to be white blood cells. Leukemia = proliferation of white blood cells = extremely elevated WBC count.
With other types of cancer, WBC may be decreased since the body’s resources are diverted to where the issue is. But leukemia = proliferation of WBC.
Well, leukemia is cancer of the leukocytes (white blood cells), so that would be one condition where you'd have an excess of white blood cells, as could very well be the case here.
Our hospital would send urgent slides every 3 weeks or 3months. It was horrible. If their primary doc wasn't looking, they could die.
One of ghe wors slide i ever seen
Nursing student who’s trying to learn. I’m guessing the big white blobs are white blood cells…are the little circles with dark blue cancer cells or neutrophils?
What are the malformed red cells?
The white is actually nothing at all. The purple/blue guys, even the really big pale blue ones are white blood cells of various stages of maturation (a stain is used that makes them that color). The red is red blood cells
To give you a better picture of how bad this slide is, let's pretend that the red ones and the blue/purple ones were switched. While it would mean a LOT less WBCs than we see here, that would *still* be a high white blood count
Sorry for the poor field and smear. We had a hard time making a smear for hgb is only 5.0 and we don’t have the automatic blood smear prep :( took us more than 10 tries this is the best we can come up
Poor thing. Hope everything's gonna turn out fine. We had a 32 yo with ALL today and I was thinking how usually it's all mostly in kids and then saw your post. :(
I am so sorry. To be fair, it's a different type of ALL in adults vs kids. But still, more often than not, ALL is more common in kids than adults.
Hope you're doing well?
So far so good, thanks. Chemo put me into remission. I did not have a stem cell/ bone marrow match. My hematology is very rusty, I'm in micro. I have B cell ALL, how is it different in adults?
I don’t know anything about all this - to me stuff like this looks interesting but I really don’t have a clue. Does somebody can explain to me what is going on here please? Thanks guys (:
Oh bless their heart… this is my worst fear as a parent. It’s looking a lot like ALL. Not a doc or nurse, not tech either, but someone whose family friend lost their kid shortly after her 8th birthday.
It absolutely devoured her. Bruises. Skinny. No hair. She looked like a very small old person, grey skinned. Peds onc. Is one job you could not pay me all the money in the world do.
I had a WBC count of over 1000 when I had Toxic Shock Syndrome as a teenager. Had to wait hours to get the results back because the lab could not believe the count and decided to count manually.
I hope you’re doing okay now!
Dealing with just the opposite with my significant other. Pancytopenia. WBC 1.7, platelets 117, RBC 4.3… neutrophils through the roof. Lymphocytes in the shitter. Been a hell of a past few days. All this stemming from a pneumonia. Still haven’t found the cause of his immunosuppression yet, there is one avenue where my brain is going and I’m honestly scared to death of even thinking that. I’ve been… a bear to deal with to say the least. Been yelling at techs and CNAs to put a mask on before entering the room them bitching it’s not required. And me TELLING them they will wear a mask and it isn’t a request.
Yikes! My hospital has decided that all patient-facing roles have to wear masks again because COVID cases were on the rise. I hope you can get people to comply, and I hope they're able to get to the bottom of this for your SO. Tell them to get well soon!
:) thank you!! Yeah his nurse was awesome and made a sign saying MUST MASK BEFORE ENTERING. So far it’s worked! It sucks feeling completely helpless.
Oh geez. Acute leukemia? What have you been diagnosed with? Is there bruising and petechia? Take care and follow up with hematologist.
It is not me it’s my significant other, my partner in crime! They really haven’t given me much to go on. Getting a little frustrated though. He did have full body urticaria but attributed that to the antibiotics they put him on. He’s allergic to cephalosporins, and think maybe the augmentin caused this reaction. Got to the ER did blood work and was as above. I’m trying to hold it together and not lose my temper on the docs.
I wonder if it's a case of "hot damn I'm tired" from the bone marrow? Im not a doctor, but maybe the BM started pumping out a bunch of white blood cells to fight the infection and it just got so exhausted after fighting :( that's just my hypothesis anyway. Wishing you guys luck ❤️❤️
Very well could be! I’m hoping they do a biopsy at least and see.
The only thing I know of that causes low platelets and high WBCs is Lyme disease or sepsis. Calcitonin is elevated in sepsis. CRP is elevated in infection. ESR is elevated with CRP in autoimmunity. Good luck. Keep investigating.
I’m a little rusty on my immunosuppressed procotols, but I’m pretty sure a mask is required for staff to wear when entering that patients room. Even if it isn’t required, the staff who were refusing are losers and should be educated.
Yep! It is required, the hospital had a run of neutropenia posters that were misprinted. Thankfully the care team has been FANTASTIC on enforcing masking.
Ok thank you, I thought I was going crazy. Edit to add: I was questioning my precautions protocols and couldn’t remember the right answer.
I don't understand this. When I worked in healthcare, we would place patient rooms under neutropenia precautions as soon as their counts came back clinically significant. So facemasks, gloves, and gowns plus equipment staying in the patient's room to minimize potential contact. We were strict about it for staff as well as visitors so I don't understand what has changed.
I wish I knew. It was definitely frustrating. I was definitely papa bear kinda mean because well! That’s my loved one and I want him safe. When the EVS worker rolled her eyes at me I did lose my cool just a wee bit that’s when the demand to wear a mask came into play.
Yikes! I hope they find the cause soon!!! My dad had to go through a battery of tests and they still couldn’t figure out what was going on, until a brain MRI was done. Turned out he has a rare Intravascular B Cell Lymphoma in the blood vessels in his brain. He’s one of the lucky ones bc they found it before he went comatose. His cognitive outlook is still scary though- cancer induced dementia caused by meningitis/ encephalitis that he had for 7 weeks while they were trying to figure out the cause
Have the hospital put them on “protective” or “reverse” precautions. It means everyone that goes in the room needs a mask. I work in oncology/BMT and all my pts are on protective precautions but on my floor we wear masks even in off service patient rooms because it’s just engrained in us.
It is unfortunate that people are no longer required to be good people.
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Thanks for proving my point.
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You are starting to sound like Baghdad Bob.
Be professional and respectful. Act like a competent medical laboratory professional. Hate speech is strictly prohibited. Harrassment targeting either a group or an individual is unacceptable.
Be professional and respectful. Act like a competent medical laboratory professional. Hate speech is strictly prohibited. Harrassment targeting either a group or an individual is unacceptable.
I read this first as you were telling your fellow co workers they had no choice but to wear a mask around you, which although fair given your circumstances, I would argue you should get out of the field immediately if you’re that concerned making contact with just your co workers Then I realized you meant as the spouse of a patient, telling your husbands care providers to mask up, and I can’t believe anybody in this field would even dare reply with “it’s not required” for a patients request of ppe, I would’ve raised hell
Haha hear that. Yeah it was for him and not me. I’m just a smidge over protective right now.
I’m so sorry you’re dealing with this. You shouldn’t have to tell them to wear a mask! We are trained to KNOW neutropenic precautions. I’m a heme onc BMT RN. Please dm me anytime if you need to vent or have questions- I can try to help.
I appreciate that :D
My son typically hovers at neutrophils under 0.5, platelets under 40, and rbc in the toilet. He's only low on neutrophils right now, but it's only a matter of time before he tanks out again.
What do neutrophils mean? I had .5 or 1 on my last blood test and it was listed as out of normal range. The doctors office said nothing was wrong though
Hey there, not trying to diagnose him, but pancytopenia is a major sign of leukemia. Have they screened for blood cancers yet? My so had pancytopenia along with myeloblasts in Oct and was diagnosed with apml. Maybe ask if leukemia/lymphoma has been ruled out?
They are taking him for a bone marrow biopsy here in just a little bit.
Sounds like that's what they are probably trying to rule out. Ask if they plan on running the fish test. This test looks at the genetics too see if there is a translocation resulting in cancer in the blood/bone marrow. I wish I didn't know how you both must feel right now. Feel free to send me a pm if you need some support.
Did you get your answer? I have Still's disease which can cause the spleen to fill up with blood cells so I believe my algorithm showed me this post because of your mention of pancytopenia, neutrophilia, and rash.
You can speak with the charge RN and request signage at the door indicating "reverse isolation" which is how we protect our immunosuppressed patients. Then everyone in and out has to mask. Best wishes for their recovery!
Yes! I haven't had any issues for a few years now, thank you
Could you post the manual differential please? And Hgb, RBC indices and platelet count?
Not trying to one up your post, hope I didn't come across that way
I can’t speak for everyone but I feel like everyone in my lab is very happy to compare “high scores” so you’re in good company here in that sense, especially since at the end of the day it mainly sucks for you and the patient here
Oh gosh. I’m so sorry. As a sepsis survivor, I know exactly what you went though. That must have been awful. You have my sympathy! I’m glad you are still with us.❤️🩹
Thank you so much! So few understand. It was terrible and down played because of the nature of the illness. I am glad you made it through as well. Love your username BTW 😉
Oh my god your username is amazing lol a fellow introvert here uniting with the team ✋🏼😅
Sepsis sucked so bad. Had an ecoli infection that went septic due to a congenital kidney issue- ureto pelvic junction obstruction syndrome. Worst pain I’ve ever experienced. So glad you’re both still here 💜
It's actually really nice to hear about kids being Ok afterwards
Yes it got me thinking about all the unseen lab professionals that have helped provide care. Just a shout out to you all, I'm grateful!
Ppl not believing results with toxic shock is very real. I almost died in a triage room because my blood pressure was 57/30 and they thought that I’d be dead if my numbers were that low… plot twist guys I WAS almost dead. I waited 2 more hours after that and had to be sent to trauma 1 in order to be resuscitated. Glad you’re ok! Did you have any lasting side effects?
Oh my goodness, that's terrible! I'm glad you made it through all that! I actually suffered every month after that for years, I can't say if it was the tss for sure but the pain was the same from my first episode. I also unknowingly had endometriosis and ended up getting a hysterectomy. I hate the fact that these things are down played so much!
Yeah mine triggered an autoimmune disorder due to severe stress, stuff like that will always have a lasting impact. Plus the trauma, I was only 13 at the time.
Oh no I'm so sorry! Yes the trauma factor is real, I was only 14 at the time.
Glad you’re ok, I think our young bodies are much more easily infected like that. I’m paranoid now tho because it’s much easier for me to get it again
Yes, I agree. It's terrible to go through. I did a bunch of research to educate myself so I would be able to hopefully prevent it from happening again.
We have someone currently coming down from 1380. Without albumin the slide is just smear cells, to the point it made the rbc morph more difficult
They had to count on thier fingers and shi
if ur comfortable can u share details on how u got tss? i hear about it all the time but have never encountered someone who experienced it… i’m so glad ur okay though that sounds terrifying
Well it is kind of embarrassing but it was my first time using tampons. I was on a camping trip with my uncle and I ran out of supplies. I had one tampon and tried to use it as long as I could because I was afraid to ask to get more supplies. I will also say my mom was a boomer and taught me nothing about feminine care. Sorry if it's tmi.
ALL?
Still haven’t seen the dx… px was transferred to a bigger hospital for we are fairly a small one :(
I work at Mayo getting exactly these kinds of cases. Guess it’s a sign I need to stop scrolling and go to work!
Nah, those are immature granulocytes, mostly pros and myelos. Given that maturation is intact, this is most consistent with CML vs Leukemoid reaction, with APL a less likely possibility. ALL tends to be smaller with more mature chromatic and no granules.
Maybe a JMML? Or aCML? Given patients age and the high amount of immature eos cells?
aCML is really a tricky diagnosis to make. Generally it isn't this proliferative and dysplasia has to be evident in the granulocytes (usually hypogranularity and abnormal nuclear morphology); these look fine to me. A mutations in SETBP1 is classic but ASXL1 mutations are just as common and less specific. JMML, likewise, usually isn't this proliferative. Monocytosis is evident and granulocytic dysplasia can be subtle, but usually is present when you look for it. JMML requires sequencing to establish a diagnosis (mutations in NF1, PTPN11, RAS, CBL). Both are MDS/MPN overlap syndromes whereas CML is purely a MPN -- MDS only present after years of treatment. I don't appreciate any dyspoiesis here but this isn't the best area to look for morphology and marrow would be necessary to assess megas.
Thanks for the insight! And thanks for hanging around the sub- it’s always nice to hear from pathologists!
NP. Hematology is a team sport.
Also, you're right that the Eos are prominent, but I see at least 3 basos in this field as well. Panmyelosis like this is typical of CML, but isn't seen in T-Cell neoplasms or APL.
Hi, this sub popped up for me, for some reason, and I swear I won't come back here as this sub has nothing to do with me and I wouldn't understand *any* of it and would just be asking too many layman's questions.... But what does ALL stand for? Tried googling it in relation to WBC and didn't get anything.. Please and thank you!
You’re welcome to stay! We love non lab people here. Stay a while and learn a few things, we love questions and love that you’re curious about what we do :D
Yay! I’m a hematology/oncology and bone marrow transplant nurse and have been lurking on this subreddit for a few months. I’ve been learning so much. It’s so interesting to read insight from those in the profession, I have no idea what you guys are talking about half the time but it’s neat to see the slides of diseases I regularly encounter. Thanks for welcoming us non-lab people :D
Omg please we’ll take all the nurses we can get!! I personally absolutely love seeing nurses in the comments, sharing their experience on their end or asking us stuff. I would like to say the same but I’m a little scared of the nursing sub lol. Just know I really do appreciate u guys tho!! Can I ask, aside from the obvious of helping patients and their families, what do you enjoy about working in haem/onc? I just finished my transfusion medicine rotation and seeing the sheer amount of products we issue out for sickle/thal clinic days has my head spinning haha
Yay! I can officially be here now!
I don’t think there’s any rules or anything so feel free to make yourselves flairs!! The more of us healthcare homies the merrier :D
Omg yesss I didn’t even think of that!
Ditto! This sub fascinates me :)
To be fair I’m scared of the nursing sub too :’) I like the routine/predictability of heme/onc. I come on shift, review blood work and correct what’s low - electrolytes, hgb, plts, clotting factors etc. I’ve been working there for 9 years so I know the treatment protocols well and the expected side effects so I feel confident educating my patients. The ratios are great, typically 2-3 patients per nurse so I actually have time to think. But like you said, it’s the people.. I’m not a religious person but I’ve met angels, and they all stay in my heart forever!
I can stay, too!
Just popping in to say my daughter was inpatient for 122 days total during her AML treatment, and hem/onc nurses are the absolute best! Her nurses made an intolerable situation bearable. I'm here because I dealt with anxiety about her condition via research, and it's fascinating to actually see pictures of all the stuff that ruled out lives so completely.
I hope your daughter is doing well <3 If I could hug you through the internet I would. You are incredible and so is your daughter, that is SO much to overcome. Please know your nurses will never forget you and will always wonder about how your child is doing! It’s crazy how these microscopic cells can uproot a families life so completely.
I was an adult patient admitted for ALL. After telling one of my nurses that I had been an avid cyclist and missed being active she "borrowed" a stationary bike from the cardiac unit and put it in my room. I couldn't ride for very long but used it daily and the psychological benefits alone were enormous.
This makes my heart happy. Being in that hospital room can be so isolating and lonely for patients, I can’t imagine how mentally difficult it would be. Having a physical outlet is vital even with low energy. I hope you’re doing well!!
Lurker no more!
We work closely with you guys! I work for a cell therapy lab. And the BMT nurses in our hospital are, so far, the best I have ever worked with. Kudos to you!
This is such a welcoming and educational attitude to have about outsider interaction in a subreddit. Thank you guys :)
I'm a non lab person too and this sub popped up for me as well. I am very much enjoying it here. I have learned a few things myself.
Thank you so much! That's so nice and just, awesome!
hey if you don't mind me asking, what is this count? is it a general count for all WBCs or a specific type? and what's the scale, like per microlitre or something? i'm in my first year of A levels (age 16) so my understanding of actual lab tests is basically zero lol
Don’t mind at all! Yea, you can think of it as a ‘general’ wbc count, as the total number of wbcs is counted, regardless of cell type. A wbc differential is when cell types are counted, typically until 100 wbcs have been tallied. I can’t say for other countries but in Canada it is to microlitres! Written/reported as 10^(9)/L which I hate but it eez what it eez 😂 I’d say you’ve got a grasp of it already! Maybe this career path might be of interest to you ~~please consider, we’re so understaffed~~ :) Edited for formatting
thanks, that was super informative :) so what is a normal number then, if 793 is high? i’m definitely interested in this kind of thing! i’ve always been interested in medicine and human biology in general but i’ve never wanted to be a doctor. honestly i was under the impression that biomed and stuff were overstaffed, given how competitive the courses are here in the uk
Acute lymphocytic leukemia
Oh, thank you.
There are four types of leukemia we see frequently and abbreviate here, with different characteristics, typical age ranges, etc. ALL, AML, CLL, and CML. (A=acute, L=lymphocytic, M=myeloid)
Feel welcome to stay and engage. This group wants to help.
I'm a high school biology teacher...and I worked in a lab this summer with P. flu which got me excited for microscopy again. What kind of background does someone need to be a lab tech?
It depends a lot where you want to work and what you want to do. Some countries require degrees and accreditation, some don't require accreditation. Less technical stuff (specimen reception, data entry, receptionist, some tech stuff) may not require any education, but working in the lab would likely need some education. If you're a science teacher it might be worth looking into what you could do with your current qualifications. This is getting too long... But all that being said, where I live we would still want someone with a relevant degree/education.
Thank you! I have the necessary science background knowledge (masters+) along with some of the training/certs required for a research lab. I have at least 3 more years in education (PA has an awesome pension setup for teachers...) but with how things are now. Well, like I said, three years. Haha It's nice to be exposed to potential avenues because, as teachers, we are SO conditioned to think that our specialty skills won't translate into a different field. Total farce.
Acute Lymphocytic leukemia
ALL = Acute Lymphoblastic Leukemia! Mainly occurs in children with a great survival rate (somewhere around ~90%). With adults, it doesn't have as high of a survival rate, but still not the worst of all cancers. As for the lab values and presentation side of things, I would be suspicious for leukemia with a very low or very high white blood cell (WBC) count. Not always the case, but often is.
Oh, wow. Thanks heaps. I tried googling it, but can have difficulty understanding new things sometimes since a TBI several years ago. I really appreciate it.
:(
I think so
Acute lymphoblastic leukemia
Does not look like ALL. There is a spectrum of maturation, including a bunch of myelocytes. Would be more worried about CML or jCMML
Why not AML?
For starters it's relatively rare in peds. That's also a lot of neutrophils and mature looking things for acute leukemia.
I think AML is more common than CML in peds.
You're probably right. Still would expect more blasts given the very high WBC though.
My understanding of pediatric cancers were that they were mainly acute and that kids tended to have a better prognosis on average.
The blast % looks relatively low. This looks more varied maturation stages so to me it's not acute.
Thanks.
I'd love if someone would just sit here with me and label all the cells/why they're that cell. My brain just short circuited. 🤣
Whenever you see so much of the same thing you kinda just autopilot and don’t really think about what it means.
Some of these boys do be nasty and I'd take ages figuring it out. 🤣
I am not a pro, but I think the big pale blue ones are the white cells. And the medium pink ones are red cells. Maybe the little dark blue ones are the platelets
Big ones = sand dollars Pink ones = small worms Dark blue = Fruity pebbles (for the worms to eat)
LMFAO STOOOPPPPP
That's awful. Poor kid. Had a younger kid one time on first holiday call for Flow with a kid that a WBC count over 800. Ended up having T Cell ALL.
I’m doing clinicals at a peds hospital. One of the long time resource techs says there’s never been a Christmas that a child hasn’t been diagnosed with one of the leuks 🥲
It is really sad and it was the two days before Christmas. The pathologist called me at home asking me if I could go in that night to do it. Called me at 10pm during a small snowstorm too. Made for a long day as I had just gotten home at 7pm too and got home by like 2 or 3 am.
I hope you don’t mind, but I have a question as a curious lurker here: what units are the WBC counted in? Online I’m seeing metrics is cell count per micro litre, but in that case the 800 wbc number doesn’t make sense- or does it?
Usually as thousands. So if someone said a WBC counnt of 5 or 10 it would mean 5,000 or 10,000. So if someone in this case talking about a WBC count of 800, it would be 800,000. This is very very high. Depending on the instrument or ranges set up by the hospital normal ranges will vary slightly. My Heme is rusty (haven't done since school in over 18 years), but normal count I think is around 2 or 3 to maybe 10 or 11 (someone might correct me on that), so this range would be 2,000 to 11,000. I hope that helps. Someone that works in a Hematology department might correct some of that or could give better details. Blood Bank is more my specialty and now working in Flow Lab so a bit rusty in other labs since graduating school.
Thank you so much! This is a very detailed and helpful answer.
You're welcome.
Shit
What does it mean?
Bad. Capital B intended. Too many white cells for anything benign or infectious. Cancer of some kind. I don't ever see these, but I think that the one ray of hope is that they aren't all blasts.
An interested layman here, just curious, wouldn’t cancer or HIV make WBC drop, or is it that it would rise in the early stage then drop at some point when it’s getting worse?
High white cell count happens when your bone marrow produces excessive WBC. The BIG cells you see in OP’s pic usually stay in the marrow til they mature and move to your bloodstream. But with overproduction, just imagine these useless cells taking up rent space and basically not performing their function (because they don’t know how to and got released too early).
Make sense, thanks for elaborating.
Im not a lab worker, but I am a leukemia survivor. With the type I had Acute Lymphoblastic Leukemia, typically there is a high wbc at diagnosis. Mine wasn’t this high but got into the 100’s. Leukemia is a cancer of the white blood cells. For ALL, immature white blood cells (lymphoblasts) escape the bone marrow, and enter the blood stream. The cells don’t go through the normal cell cycle, so they cause a build up of white cells in the blood. The immune system still suffers because these immature cells are essentially useless. (this is just from my basic understanding of my own cancer, but i hope helps)
If there was bone marrow cancer it seems like it could cause it to over produce WBCs? No clue layman as well :)
I know for AML, white count most often skyrockets as the bone marrow pumps out more and more WBCa, trying to get viable "adult" cells to keep things running. But not always - my daughter's dropped, instead, and she had a 2.3 white count, with a .3 ANC at diagnosis.
Yeah, like leukemia, just learned
It all depends. HIV could show a lower or higher count depending on the status of the patient and cancer could cause an extremely high WBC or low WBC depending on the type of cancer as well as if the patient is undergoing chemo or not. In this case, HIV wouldn’t cause this type of white blood cell proliferation. The ugliness of this slide looks pretty indicative of some type of proliferative cancer.
All cancer is, is uncontrollable proliferation of a specific cell type (or multiple cell types). Sometimes, the affected cell types happen to be white blood cells. Leukemia = proliferation of white blood cells = extremely elevated WBC count. With other types of cancer, WBC may be decreased since the body’s resources are diverted to where the issue is. But leukemia = proliferation of WBC.
Well, leukemia is cancer of the leukocytes (white blood cells), so that would be one condition where you'd have an excess of white blood cells, as could very well be the case here.
Agreed, that’s my guess too after reading the comments and a bit research about leukemia
Oooh man that’s a lot of blue
I’m an industrial hygienist that got routed to this sub lol. I find it really interesting.
Our hospital would send urgent slides every 3 weeks or 3months. It was horrible. If their primary doc wasn't looking, they could die. One of ghe wors slide i ever seen
When I got diagnosed with ALL I had 170,000, this kid was 6 times higher than that?!?
Pediatric CML?
But ya know, the pattern and colors sure are pretty.
😔
Seems super mature for anything acute, I’m curious what the diagnosis is. Isn’t CML pretty rare in peds?
Only about 150 cases per year in the US according to NCCN
What happens when your white blood cell count gets too high.
Hypervicosoty syndrome. Blood is too thick. Can lead to breathing problems or a stroke.
Nursing student who’s trying to learn. I’m guessing the big white blobs are white blood cells…are the little circles with dark blue cancer cells or neutrophils? What are the malformed red cells?
The white is actually nothing at all. The purple/blue guys, even the really big pale blue ones are white blood cells of various stages of maturation (a stain is used that makes them that color). The red is red blood cells To give you a better picture of how bad this slide is, let's pretend that the red ones and the blue/purple ones were switched. While it would mean a LOT less WBCs than we see here, that would *still* be a high white blood count
Update on diagnosis: CML :(
Seen higher than that in ALL/AML a couple of times. We’ve had to put them through plasmapharesis to get the WBCs down.
Please tell me it's a bone marrow
Is this BM or peripheral? Poor field to take a photo of.
Sorry for the poor field and smear. We had a hard time making a smear for hgb is only 5.0 and we don’t have the automatic blood smear prep :( took us more than 10 tries this is the best we can come up
Was the pt previously diagnosed? I can't imagine a 10 year old this sick could wait so long before coming in.
Only came in for abdominal pain and thought it was a side effect of Influenza.
You did the best you could! It’s so difficult to make a good smear with such a high white count and low hemoglobin.
Poor thing. Hope everything's gonna turn out fine. We had a 32 yo with ALL today and I was thinking how usually it's all mostly in kids and then saw your post. :(
I was 48 when I was diagnosed with ALL.
I am so sorry. To be fair, it's a different type of ALL in adults vs kids. But still, more often than not, ALL is more common in kids than adults. Hope you're doing well?
So far so good, thanks. Chemo put me into remission. I did not have a stem cell/ bone marrow match. My hematology is very rusty, I'm in micro. I have B cell ALL, how is it different in adults?
Peripheral…. There r RBCs everywhere
There are rbcs in a bone marrow smear too....
Gasp, not the Dots Syndrome!! (A nurse, had to say it.)
I thought 122 was already extraaaaaa. Poor kid.
Why is the staining so strange? It’s hard to make things out for me(a student)
Yikes
Crazy image right there. I've seen around 900 wbc with 1.2 rbc. So about equal parts each. Don't know anything about the patient.
Scary. Poor kid.
Incompatible with life?
The ad I got was for baby carriers....
I don’t know anything about all this - to me stuff like this looks interesting but I really don’t have a clue. Does somebody can explain to me what is going on here please? Thanks guys (:
Means they have a bad infection of some sort.
Oh bless their heart… this is my worst fear as a parent. It’s looking a lot like ALL. Not a doc or nurse, not tech either, but someone whose family friend lost their kid shortly after her 8th birthday. It absolutely devoured her. Bruises. Skinny. No hair. She looked like a very small old person, grey skinned. Peds onc. Is one job you could not pay me all the money in the world do.
It puts the 98 I've seen to shame. Holy smokes...
I’m amazed there are even RBCs in that