Dr. Holodniy,

My most recent, reconfirmed, CBC shows (compared to a month ago) a huge drop in Lymphocyte percent from 40 to 20 (normal being 20 to 50) and a drop in Lymph # from 3.2 to 1.7 (normal being 1.2 to 3.4). Monocytes are also way down.

The "GR" percent is way up, from 52 last month to 74 now (normal being 42 to 75).

Last month's CBC numbers are more the norm of what I have had, so this month's CBC is a big change and a bit of a shock. My questions, on which I would appreciate your advice are these:

a. Is the large drop in Lymph numbers within normal fluctuation or would it more usually signify a big increase in viral load and activity?

b. If my CD4 percent remains the same (at 30), am I correct, with a WBC of 8, that I would have had a drop in CD4 cells by 480 in one month (WBC's times Lymph times CD4 percent?)?! Is that possible? I will have a new T cell subset done, but your comments on whether a depressed Lymph and number in a CBC usually correlate to depressed CD4 counts would be appreciated.

c. What do "GR"'s (granulocytes?) do and what does a large increase mean? Is a high number of GR's relevant to the health of the immune system (like high CD4 counts would be)?

I will have another CBC in a month, but the numbers were run twice on this one and I would very much like to know the significance. How there could be so many large changes so quickly?

Many thanks for your advice and perspectives.

You don't indicate what your viral load level is or what the trend over time has been. Also, are there any other ongoing infections, active medical problems, or recent medication changes that might account for this change. The best thing to do is repeat the numbers. The granulocytes are important immune cells primarily involved in bacterial and fungal infections.