Q: critical lab value (low) for WBC

[Guest guest]

Hi! I don't know what the panic level is for WBC, low critial value... Please, share your knowledge and experience!

Background:

41 yo female who presented to me Nov 2011 with CC:\\ lack of stress managment, past high chol (240's --> eats oatmeal to keep it low), and interrupted sleep. Overall, she says she's 'healthy': vaginal birth 2005, no smoking/ alcohol drinking/ caffeine, training to be a yoga teacher. 5'8" andd 126#.

We started blood-type diet, BTGs (castor oil packs, dry skin brushing, lifestyle, etc.), probiotics. Spouse has been a 'closet' alcoholic for years, apparently, and she just found out. Marriage is shaky.

I have three sets of labs from Nov 2010, Dec 2011 and May 2012...

WBC (ref range 4.0-11.0) has decreased from 6.1 to 4.1 to the NOW CRITICAL VALUE OF 2.8 thou/ul

RBC: (ref range 4.00-5.40) 4.03 to 4.11 to low value of 3.97mil/ul

MCH (27.0-31.0): 31.5 to low 31.4 to high 31.7

Platelets (150-450): 225 to 192 to 176 (IN RANGE, BUT DECREASING TOWARDS LOW)

Absolute Neutrophils (2.00-7.50 thou/ul): 4.1 to 2.4 to low 1.54

Absolute Lymphs (1.2-4.0 thou/ul): 1.6 to 1.27 to low 1.01

Other pertinents: hypothyroid. Vit D went from 34 in Dec 2011 to 81 in March 2012 with 10,000 IU qd x 30d, then 5,000IU qd x 30days then 2,000 IU qd until re-test. I've NEVER seen a Vit D level increase so quickly.

She isn't acutely ill. I'm thinking bone marrow or autoimmune issues. What next tests do I run? Am I obligated to call the patient ASAP with a critical value? And say what?

Thank you for your timely reponses!!

Leigh

Dr. Leigh H. White

Naturopathic Physician

Natural Family Health, LLC

East/ West Healing Arts Center

410 State Street

North Haven, CT 06473

www.naturalfamilyhealth.net