Really bad labs!

[kc2015]

Hi all, I have a call into my doctor who wants me to call him tomorrow because he is not at a place where he can think. Need to get new doctor. My labs have been funky since December 2015 and today after a course of 60 mg a day prednisone for my hearing loss (thought to be autimmune related) my wbc is 19.8, rbc are 5.65 and platelets are 505. My esr and crp are normal. I've been on prednisone 5 days from the test. I am very concerned because of high end. I've been feeling exhausted with the prednisone and really want to stop. Prior to prednisone my wbc has already been elevated hovering around 11-13 with no discernable infection. Not sure if I should see a hematologist? Obviously stop prednisone, taper down but any recommendations or insight would be greatly appreciated!

[Linda196]

First and foremost...DON'T PANIC!

Yes, those values are elevated, moderately.

Without a differential (breakdown of the WBC) to show if there is a specific type of white cell elevated, it's very difficult to tell what the nature of the total elevation is, whether from infection, inflammation, pre-existing immune system dysfunction, or medication. 

The RBC needs to be seen as a factor in an equation including hemoglobin and hematocrit to see if there's an underlying pathology, or it's a result of dehydration or chronic disease.

The platelets could reflect what is called secondary thrombocytosis; elevation as a result of chronic infection or inflammation, which is considered a benign condition. In order to diagnosis primary thrombisis, from a pathological cause, further blood test and possibly bone marrow studies would be required.

You only mention blood work from December, are there any values from just prior to the start of the Prednisone trial, or could these values have been climbing since December and only detected after the Prednisone?

All of these results are better discussed with your doctor, and a hematologist if you or your primary feel the need. As you noted, Prednisone from 60 mg should never be stopped without a taper, although if you've only been taking it for five days, a very quick taper may be possible

[kc2015]

Thank you for your response. My elevated and has been consistent since December with values of 12-13 @ 3 month intervals with elevated crp. I do get yeast infections often from the dryness. And I have intestial cystitis. My platelets have been slightly elevated since diagnosed in 2007 so I assume it's chronic due to inflammation. My hematocrit and hemoglobin where within normal ranges. I m also on plaquenil since January but that hasn't really changed the end count. I know the prednisone at such a high dose is the most likely culprit . my glucose is now elevated, normal on prior labs, as well as alt elevations. I just always heard about people feeling good on prednisone. If the labs were funky and I was feeling great that would be one thing but I honestly feel worse which in itself concerns me.

[kc2015]

Oh the wbc have always been elevated in neutrophils with latest lab being the first one showing immature granulocytosis. I assume that is since prednisone is causing bone marrow to produce wbc.

[Navigator]

Hi

I also developed autoimmune hearing loss, or it is genetic.  I was given a course of steroids to see if that had an impact.  It did not appreciatively improve my hearing and given the toxicity of the drugs (monthly labs needed) I chose to discontinue the drugs and get a hearing aide (actually two).  I can now hear just fine.

Perhaps you should see if the drugs are working to improve your hearing...if that is the only reason you are taking them.  If not your choice is easier.

[kc2015]

Thank you. I currently wear bilateral hearing aids. My hearing has ranked in recent months hence the decision to start prednisone on August 28th. Essentially it was a course of steroids or cochlear implant since my hearing is so bad. I am 35 yrs old. But your right the prednisone is a serious drug and if not making a big difference for hearing I will stop. My hearing md is kinda making me seem "weak" for quitting prednisone 10 days in but if you feel bad I don't think you should be quilted to take a medicine unless it's life or death. I think 10 yrs into my autoimmune battle I know my body better than a lot of docs think they do

[irish]

Have you seen an ENT and/or an immunologist? I have autoimmune ear disease and lost my hearing in the right ear in 1997 and am now working on losing it in the left. Have about 50% hearing loss in left. I see an immunologist and had blood work that shows 2 antibodies that can be responsible for hearing loss. I have been on IVIG for 10 years for my myasthenia gravis which obviously didn't stop this autoimmune ear disease.

My immunologist says that oral high dose steroids just don't do the job for hearing loss. He put me on pulse steroid therapy which is 1000 mgm solumedrol in one hour(intravenous) and I get this once a month. I started in May and will be through in Oct unless doc wants me to continue. I will have a hearing test again in Oct to see if the loss has stabilized.

There seems to be a lot that you need to have checked out to fit all this together. If it was me I would find a good ENT and get the hearing issues reassessed. This way you will know where you are hearing wise. It would be good to get a referral to an immunologist who can do the appropriate testing for these antibodies. I would be really surprised if a rheumatologist or many other doctors would know which blood work needs to be done to ascertain positive antibodies for hearing loss. They are really very specific blood work. I wish you well in your endeavor. Irish