Neutropenia

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My husband is 53 years old and in excellent health -- doesn't drink, exercises regularly.  He has a bicuspid aortic valve that is being managed with Lisinopril, and he had a prostate biopsy last year that came back negative, and since then, his PSA is within normal range.  Last month he had a routine physical and his wbc came back at 1.9 with neutrophil ABS at 0.4.  He has received no treatment thus far, the doctor has adopted a "wait and see" attitude and ordered weekly cbc's.  This last week's was: wbc at 2.8 and neutrophile ABS at 0.7 (down from 0.8 the week before).  All other counts are normal, it's just the neutrophils that are way off.  He has been tested for vitamine b-12 and folate deficiencies, HIV, ANA are negative, and we do not remember him having ANY type of viral infection except a slight cold maybe in early June.  Sed rate is 4.  He has no symptoms of illness whatsoever and feels "perfect".

Of course I'm worried about leukemia or MDS.  We see the hematologist next week, but she doesn't seem overly concerned like we are.  I would expect the next course to be a bone marrow biopsy, but how worried should I be about this neutropenia?  

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Thank you for the prompt answer, it set my mind at ease a little.  We just got back from the hematologist this morning and his latest bloodwork shows WBCs at 4.2 and neutrophils at 2.2, which are all within range :)

However, he's had a mild cold this week -- no fevers, just a runny nose.  I know that can increase both these counts, so I'm not ready to celebrate just yet.  Today the doctor scheduled a bone marrow biopsy (before we got the latest lab results).

My question is, would a mild cold raise these counts this much in a week?  Last week his WBC was 2.8 and neutrophils 0.7.  

[PaulMD]

Hi.

Leukemia would present with just the opposite, which is extremely elevated white cell counts.  MDS, can indeed present with low WBC's but this is more likely to be accompanied by lower levels of other blood components such as red blood cells and platelets (if all blood components are low, we call this as 'pancytopenia').  

Viral infections can really cause some form of neutrophil depression and I first handedly saw this with my brother last week.  The hematologist consult is welcomed just to rule out other causes but I will not be surprised if she would not find anything seriously wrong.

For now, have him eat a balanced diet with lots of fruits and vegetables and have adequate rest.

Regards and God bless.