by George Taniwaki

The results from my recent complete blood count (CBC) test are back and the transplant nephrologist at Univ. Washington Medical Center, Elizabeth Kendrick, doesn’t like my low white blood count. She has referred my case to a hematologist. This is a bit worrisome. Low blood count can be a caused by many things. The most serious ones are infections that attack white blood cell like HIV and cancer of white blood cells like leukemia or lymphoma. I reply by email with the following additional medical background that I hope will be helpful.

  1. I feel fine.
  2. I’m not on any medications.
  3. I haven’t had any recent infections or allergic reactions. I have had episodes of pityriasis rosea in the past two summers. I believe each was brought on by a spider bite since it starts about a day after a sudden painful stabbing sensation in my hand (2008) or leg (2009) while working in the garden. I never actually saw a spider though.
  4. It is unlikely that I can find any earlier CBC test results for comparison. Until I decided to become a kidney donor I hadn’t been to a doctor in several years. I think my latest checkup was in 2003.

The table below shows my white blood count and leukocyte counts since volunteering to become a kidney donor.

Date Laboratory White blood count
(normal range 4.3-10.0)
Leukocyte count
(normal range 1.0-4.8)
6/8/2010 UWMC 3.52 0.65
9/25/2009 UWMC 3.43 0.65
9/16/2009 UWMC 2.99 not performed
3/10/2008 LabCorp 3.8 0.8

As you can see, my white blood count is about 20% below the minimum for normal and the lymphocyte count is about 30% below the minimum for normal. But neither is close to zero and the numbers have not been bouncing around the past two years. (Leukemia and lymphomas are often characterized by a rise in leukocyte count as the disease spreads, followed by a fall as the cells are killed off.)

I contact various people in an attempt to find additional comparative CBC data.

  1. I call the Puget Sound Blood Center. I’ve been a donor since 2001, but discover they do not perform a CBC on donors. (That’s worrisome in itself. But it explains why they ask you to fill out a medical questionnaire each time you donate.)
  2. I call my GP from 1996. Her assistant says records for patients inactive for more than 7 years are destroyed.
  3. I call the clinic of my GP from 2003. She is no longer with the practice, but her records may still be in archive storage. I fill out a form to request them, but it may take a month. Too late for the UWMC, but might make an interesting blog post for later.
  4. I send an email to my brother to see if he has any CBC numbers to share. Perhaps his are low as well and it is a familial trait.
  5. However, I don’t contact my mother. I don’t want to alarm her, so I won’t tell her. (She’s not much of a computer user and I don’t expect her to read this blog post either.)

I soon get an email response from Kami Sneddon, the transplant coordinator at UWMC. The hematologist would like to perform a bone marrow biopsy. I schedule it as soon as I can, but the earliest I can get an appointment is for this Wednesday, June 23. We’re cutting it awfully close. I hope this doesn’t cause my donor surgery, currently scheduled for next Wednesday, June 30, to be cancelled.

****

After learning that I have a low white blood count (WBC), it dawns on me that I am not at high risk for cancer or blood-borne diseases. If I was a normal patient rather than a potential kidney donor and had these CBC results, a doctor would not order a bone marrow biopsy and the insurance company would likely refuse to pay for it. However, I am not the only one at risk, the recipient is too. Transplanting tissues or organs multiplies the risk of disease by providing a transmission path. A case has been documented in which three recipients were infected with rabies transmitted by a single deceased donor.

Even more important, transplanting an organ from a donor who has any unusual characteristics and later discovering the donor has an infection or cancer would be grounds for a malpractice suit, probably even if the recipient does not get sick (due to mental anguish and emotional distress). So the bone marrow biopsy is not really for my benefit. It is defensive medicine. However, given the high potential cost for this low probability event, it is an understandable precaution. Note that the cost to UWMC would not just be the lawsuit. They would lose business if patients did not trust them, and the public would be hurt by an overall reduction of trust in the medical system.

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