Lymphoma is a blood cancer where lymphocytes (certain types of white blood cells) develop abnormally and crowd out healthy cells. The two main types of lymphoma are Hodgkin lymphoma (also called HL, Hodgkin disease, or Hodgkin’s disease) and non-Hodgkin lymphoma (also called NHL or non-Hodgkin’s lymphoma).
People living with lymphoma need numerous laboratory tests before, during, and after treatment — including blood tests. Although blood testing can’t diagnose most types of lymphoma, it can help your health care team understand how lymphoma and your treatments are affecting you.
There are several types of blood tests for people with lymphoma. Each can be used to reveal details about different aspects of your general health. The most common type of blood test for lymphoma is a complete blood count (CBC), also known as a full blood count. This test uses a blood sample to measure the number of different types of cells in your blood.
The abbreviations that appear on CBC results can be confusing. Here is a breakdown of what is tested for in a CBC and what its results can tell your doctors.
A CBC will measure how much of each type of blood cell you have in your blood. The three main types of cells are:
A CBC test will usually measure your hematocrit and hemoglobin levels as well. Hematocrit levels measure how much of your blood, by percentage, is currently made up of red cells. Hemoglobin is a protein in red blood cells. Measuring hematocrit and hemoglobin can help doctors better understand how well your RBCs are doing their job of carrying oxygen to the tissues in your body.
The number of each type of cell in the blood is often referred to as the “count.” Many of the treatments used for lymphoma can affect your blood counts, as can lymphoma itself. Usually, blood counts return to normal after cancer treatment is complete.
On a CBC, levels of red blood cells, white blood cells, and platelets are typically expressed as the number of cells per microliter of blood. Normal blood counts vary from person to person. However, there are general normal ranges for men, women, and children.
The normal range of red blood cells per microliter is:
The normal range of white blood cells per microliter is:
White blood cells are also measured by the ratio of WBC types — the white blood cell differential. There are five main types of white blood cells: neutrophils, eosinophils, lymphocytes, monocytes, and basophils. In a normal blood count, the WBC differential comprises:
Normal ranges for hematocrit levels are:
Hemoglobin is expressed in grams per deciliter (gm/dL). Normal ranges for hemoglobin are:
Finally, platelet counts — regardless of age or gender — are considered normal at 150,000 to 400,000 per microliter.
What do abnormal results mean? For any given value, a result can be too high, too low, or unusual in relation to another value. For instance, the white blood cell differential may show an abnormal skew in WBC types. Abnormal results can indicate an issue in the bone marrow — where blood cells are made — or a variety of other disease processes.
Although normal ranges are an expression of what is normal for the majority of healthy people, those with underlying health conditions may have lower or higher ranges than would be considered normal for them. A person living with heart disease, for example, may normally have a higher-than-normal RBC count.
Your CBC results will help your health care team better understand how your lymphoma and lymphoma treatments are affecting your body. If your results show that your risk for serious side effects or complications is rising, your doctor may make a change in your lymphoma treatment or prescribe other medications to address the problem.
If someone’s RBC, hematocrit, or hemoglobin counts are low, the person is considered anemic. Anemia may occur when there are too few red blood cells being made in the bone marrow, or when the red cells are being destroyed by disease. Anemia can also be a consequence of low levels of iron, B12, or folate in the diet, along with other potential causes — including heavy or persistent bleeding. The primary symptoms of anemia are fatigue, weakness, and pale skin.
Many people with lymphoma experience anemia at some point, either as a side effect of lymphoma treatments or because of the lymphoma itself.
If your RBC count, hematocrit, or hemoglobin are low, your doctor may order a follow-up blood test called a reticulocyte count. Reticulocytes are immature RBCs. Counting them can help determine whether the problem is reduced RBC production or if the cells are being destroyed.
If red blood cell levels are too high, it may mean there is not enough oxygen in the blood. It can also indicate dehydration. In rare cases, a high RBC count may be due to polycythemia vera, a type of blood cancer in which RBCs are overproduced by the bone marrow. Overly high red blood cell counts are treated by drawing blood until the count is lowered. In some cases, medication might be used to reduce the amount of red cells.
An overall low white blood cell count, also called leukopenia, may mean the body’s ability to fight infection is impaired. If there are fewer neutrophils in white blood cell counts, this is called neutropenia. When neutrophils are low, normal symptoms of infection may not show up, since those symptoms are specifically caused by the reaction of neutrophils fighting infection. This can lead to infections lasting longer and being harder to treat.
Low levels of lymphocytes mean the body cannot detect or fight viral infection as easily as usual, as lymphocytes are the cells that react first to viruses. If a test has shown you have low white blood cell counts and you develop a fever, you should seek immediate medical attention, as this may be the first sign of a serious problem.
Certain types of cancer, including lymphoma, may lead to an abnormally high white blood cell count. A high WBC count, also known as lymphocytic leukocytosis, can also indicate an existing infection or dysfunction in the immune system.
A low platelet count — also referred to as thrombocytopenia — can indicate potential problems with bleeding. People with lymphoma may be at higher risk of low platelet counts.
Thrombocytopenia may occur when too few platelets are being made in the bone marrow or platelets are being destroyed. In some cases, the body does not recognize the platelets as part of the immune system and attacks them. Symptoms of a low platelet count include:
Low platelets are commonly treated with transfusion, but your doctor may suggest other methods to reduce the chance of bleeding. If a blood test shows your platelets are low, your doctor may recommend avoiding common nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen, or ibuprofen. These medications can interfere with the blood's ability to clot.
A high platelet count is called thrombocytosis and may be the result of cancer. High platelet counts can lead to stroke, heart attack, or a blood clot in a vein. Thrombocytosis is treated with medications that reduce the blood’s ability to clot or with medications that inhibit platelet production in bone marrow.
When the body’s levels of red blood cells, white blood cells, and platelets are all lower than normal, it is referred to as pancytopenia. Pancytopenia can be caused by:
Blood tests make many people with lymphoma nervous. Results may show how well treatment is working or whether side effects from treatments are becoming more severe. “I had blood work done, and I’m waiting for results. I may have to start doing treatment. That frightens me,” wrote one MyLymphomaTeam member.
“Blood tests came back with great results, so waiting for another round of scans in three months,” shared another member.
Members often provide each other with encouragement and positive words to help get through the stress of blood work and other aspects of living with lymphoma. “You can do it. Stay positive and surround yourself with positive people. It helped me a lot,” one member wrote.
“Keep the faith; take one day at a time. Do things that make you happy and taste good,” another member suggested.
Another member shared their gratitude for their support network: “This group has been a great support. It’s encouraging to hear of others’ experiences!”
Lymphoma and its complications can be daunting, which makes support crucial. When you join MyLymphomaTeam, you gain a growing community of more than 7,000 people living with or caring for someone with lymphoma.
Do you get anxious when waiting for blood count results? Do you have any tips for dealing with stress around blood tests? Comment below or start a conversation on MyLymphomaTeam.
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