Fever With Low Platelets and White Blood Cell (WBC) Counts

Q: Hi, I m down due to flu since last Friday. It took almost 5 days for fever to subside, though the temperature never crossed 101 degrees. I have been taking paracetamol continuously since Friday. In the interim on Monday, to ensure that there is no malaria, basic blood test was done. Reports were normal accept low WBC and platelet counts- 3300 and 1.25 thousand respectively. I did another report today. The counts have further weakened to 2900 and 1.14 thousand. Fever is under control since last 2 days. I need help to understand possible reason for low counts. Widal and urine tests were OK.
– By Pankaj,  age 32, male.

Reply:

You definitely have some neutropenia and thrombocytopenia, that is low  platelets and neutrophils. This cannot be explained by the viral fever you just had.

Further investigations are definitely required at the earliest. I would suggest you to visit a hospital and get the following investigations done:

Test for Dengue: Any viral looking episode accompanied with low platelets counts call for this investigation. It is imperative to rule it out first.

If dengue is negative, there is a possibility that you are having some other underlying medical problem which has made your blood counts low. Low neutrophil (WBC) counts make a person more prone to infections. He frequently catches infections, viral fever.

To diagnose the problem, certain Hematological investigations have to be done. They would include-

  • Total blood counts
  • Peripheral smear

It would be best for you to visit your nearby hospital and get yourself investigated. You may also let us know about the results.

Take Care,

Buddy M.D.

Medical Advice (Q&As) on “Fever With Low Platelets and White Blood Cell (WBC) Counts

  1. Pankaj

    Hi, I had read somewhere that acetaminophen(paracetamol) use in rare cases can result in low WBC and platelets. Can that be the reason for my low counts? Fever is still in control. I have not taken any medicine in last 24 hours.

    Full CBC result is also shared below for advice :-

    Hemoglobin 14
    RBC 4.92
    PCV 41.7
    MCV 84.76
    MCH 28.46
    MCHC 33.57
    RDW SD 12.5

    Neutrophils 23%
    Lymphocytes 70%

    Eosinophils 5%
    Monocytes 2%
    Basophils 0

    MPV 9.8

    Reply
  2. Buddy M.D. Post author

    Yes, paracetamol (acetaminophen) may cause low platelets and WBC counts as a rare side-effect. It’s good that your fever is under control. But we still suggest you that you keep an eye on your blood counts. And also ask for a blood peripheral smear when you get your blood counts (CBC). Make sure that they come back to normal. Otherwise you may need further evaluation.

    Reply
  3. Nplatetlet

    Sir,
    MY blood report is as follows:
    Platelet Count = 129 thousands/mm3; normal range is 150-450.
    Hb 14.3g/dL.
    Sugar fasting 113 mg/dL.
    Rest report of CBC/ LFT/Urine are alright
    Please advice how to increase the Platelet count level?
    Why it has gone down? What could be the possible reason? Thanks.

    Reply
    1. Buddy M.D. Post author

      What are your symptoms? Are you taking any medications?

      Low platelet count can be as a side effect of certain medications or as a component of some illness.

      Reply
      1. Nplatlet

        Sir, Vildagliptin 50 mg OD
        Metformin 850 mg BD
        Telmisartan 20 mg OD
        Rosuvastatin Calciun 10mg OD; total cholesterol is 85
        pantocid (for gas)
        Are any of the above medicines are causing side effect for lowering platelet count?
        Thanks.
        I am taking following medicines for sugar, blood pressure and cholesterol.

        Reply
          1. Nkjn

            Sir, thanks.
            Should I stop rosuvastatin or change with some other medicine? Please advice which medicine I should take.

          2. Buddy M.D. Post author

            You’ll have to take this medicine till your blood cholesterol levels come within the normal range.

            Be aggressive about dietary management of cholesterol. Try controlling this parameter by your diet and lifestyle, and no medicines.

            You may talk to a medical dietitian regarding this.

  4. Nplatelet

    STOOL CULTURE
    Sir,
    thanks. I am giving below the report of stool culture. Please advice whether it is alright or not. Further does it have any adverse affect on reduction of platelet count. Any further treatment/test is required.

    Result: Escherichia coli grown (Normal Flora)

    – No Salmonella Spieces grown
    – No Shigella species grow:H7) grown
    – No enteropathogenic Escherichia Coli (O157:7) grown
    – No Vibrio Cholerai grown

    Reply
    1. Buddy M.D. Post author

      The stool culture is alright. Nothing abnormal, so no medical intervention is required.

      Your statin medicine, the one you take for cholesterol, may be giving you the low platelet count. Proper dietary measures would help you wean off this medicine.

      Reply
  5. Shilpa

    Sir, my daughter had a fever from past ten days and I took to hematologist specialist. They took a bone marrow test and result is all normal only WBC is low for that he suggest us not to take any medicine if she get fever also. After a week again he did CBC test in that her WBC come up from 1.6 to 6.5
    Doctor prescribed few tablets fesovit and neurogem for three months.
    Now after 4 days again she is having fever from past 2 days, please advice.

    Reply
  6. Githa

    Hi doc, can I know what is the lowest white blood count a person can have due to dengue fever? What is the count if need to b classified in severe dengue fever category? Thanks

    Reply
    1. Buddy M.D. Post author

      TLC counts are usually low in value in such fevers.

      To categorize dengue as severe or moderate, doctors focus more on the Hb% levels and platelet levels.

      Reply
  7. sandeep

    Hi doctor

    I had done CBC in Marc 2017 my TLC was around 4800 and in september CBC it was around 5400 i did CBC in January and it came with TLC count of 2900..I have been taking doxycycline for almost a month twice a day does taking antibiotics for such long time will bring the TLC count drastically ..I have fungal/bacterial infection on my urethra ..for which my urologist had given me doxycycline

    Reply
    1. Buddy M.D. Post author

      Any other symptom, like recent weight loss, fatigue etc.?

      Yes, long term doxycycline use may reduce blood counts.

      Reply
      1. sandeep

        No i am not having any weight loss fever , yes i feel slightly weaker but not that i can call fatigue ..I had one HIV WB in october last year it turned out negative and do does test for HCV,HBsAG, i had slight sphenoid sinusitis and the doctor had given me ceftriaxone 1000 Mg as IV this was around 10 days ago ..Apart from this in january i had taken Doxycycline for more than 15 days …

        What are the chances of HIV not getting detected in blood samples even after one year ?

        Reply
        1. Buddy M.D. Post author

          Well, this is likely to be a side effect of doxycycline. The counts would recover with time after you stop the drug.

          Reply
          1. sandeep

            Well i had done a CBP yesterday and my TLC count is back to 4200 level now from the 2900 it was one month ago this is after i completely avoided taking doxycycline and other medicines ..But my lymphocytes is still High at level 42 this is almost a year full of H level above 40 for my lymphocytes. I also had done Vitamin B12 test and its at level of 105 is it extremely low as the normal range shows 200 .What should i do now for the Vitamin B12 deficiency ..

            Thanks

          2. Buddy M.D. Post author

            Start taking Vitamin B12 supplements asap. Your doctor may even suggests injections for it.

            As the deficiency improves, most of your problems would resolve. Your energy level would also become better.

  8. sandeep

    Yes sir my doctor had told me to get Vitcofol 2ml for 5 alternate days ..Will this improve my B12 deficiency as i had low B12 for more than 3 years now but this is first time doctor told me to take injections immediately..Will this 5 dose will be enough to bring my B12 back to normal levels ..i am still having very high fatigue and lots of numbness and tingling pain .. does prolonged B12 deficiency will cause some server damage to my health conditions ???

    thanks

    Reply
    1. Buddy M.D. Post author

      Dose is usually enough. The effects may take time to come.

      However, you may be asked to go for repeat blood tests to check results.

      Reply
      1. sandeep

        I had just repeated my B12 test after taking a month of supplements it has increased to 242 level from my 102 level but there is something which is making me worry more ..My lymphocytes have gone up to 67 now from the 42-46 range it was hovering around for last one year ..What is the reason my body is generating such high levels of lymphocytes for last one year ??? is there any particular test which i can run to understand the underlying cause of this high lymphocytes ?? i had done HIV,HSV,TPHA and Chlamydia all those test have turned negative so far ..is there something more serious health issues i am having ? like early stage of cancer i had been diagnosed with HPV type wart on my glans couple of years ago not sure if its is causing the high lymphocytes …

        Reply
        1. Buddy M.D. Post author

          Increase in lymphocytes may be seen if you have any infective or inflammatory state in the body now or in the recent past. Even common viral infections, sore throat, etc, may increase the counts.

          Any other symptom you’ve noted in yourself since the past one year, pain anywhere, weakness, yellowing of skin, cough, stomachache, problem urination etc.?

          Reply
          1. sandeep

            I had this wart on my glans almost 15 months ago which got removed and also had candida on my glans and since then i started getting rashes on my glans which come and disappear my dermo told me to do HSV test which i had repeated thrice in the last 15 months and all returned negative.I get slight fever once a month and goes of in two days, For last 12 months i keep getting pins type pain all over my lower leg and back and also some times in my armpits on the left side , apart from this i also get pain in my groin and and in my lower back. Well i read somewhere lymphocyte will only react to viral infections but does it also react for bacterial or fungal infections ??? I am really frustrated so far i visited two Two urologist, One Infection disease specialist and one Dermatologist..No one is able to tell me what is really causing those rashes on my glans and this high level of lymphocyte

            HIV Duo : Negative
            HSV Duo : Negative
            CMV IGG : Positive (1126) IGM :Negative (0.20)
            TPHA: Negative
            Chlamydia Negative
            HBsAG Negative
            HCV: Non Reactive
            VDRL : Non Reactive

            Here are my latest CBC Ranges

            PCV : 40.5 % below Normal Range of 42 %
            MCHC : 37.8% Above Normal Range of 32-36
            Absolute Lymphocyte Count : 3135/c.mm Above Normal Range of 1000-3000
            Absolute Monocyte Count : 165/c.mm Below Normal Range of 200-1000
            Absolute Basophil Count : 0/c.mm Below normal Range of 20-100
            Lymphocytes 57 % Above Normal Range of 20-40
            Neutrophils Count : 38 % below Normal Range of 40-80
            MPV 9.8 fl above normal range of 6-9.5

            I just want to know what i causing this and start treatment so that it don’t cause me some irreversible damage ..

            Yes one more for last 8 months i have eye issue with blurry vision and slight white discharge which my ophthalmologist not able to pin point its viral or bacterial or just allergic

          2. Buddy M.D. Post author

            Lymphocyte rise is demarcatedly seen in viral infection, as you understand. You may be having a skin virus affecting your genital regions.

            Have you tried any medicines over the penile lesions. If yes, what were they? Any results?

  9. M.ali

    Sir
    I fever and chill and body pain 5 days and start eyes uper side pain and lose motion start i taken medician fever fansodal maralia but test repost negative maralia and cbc test report is plats count 126000 and wbc 2800 to normal 4000_11000 and i stop medician and only 5 days back to back oxideil 1 gram and 1 500 ml ringle 1 inj gravinet and test tlc again wbc 4100 but plats count low 126000 normal range 150000_450000
    Plz what a problem me now not fever no eyes pain no body pain only no mood eating and dipression . tension .

    Reply
    1. Buddy M.D. Post author

      Since most of your symptoms have got better now, you appear to be healing. Just give it time. Your platelet counts would gradually return back to normal.

      For now, take a healthy diet. Include plenty of fruits and vegetables in your diet. Drink lots of water.

      Reply
  10. sandeep

    I did tried anti fungal and anti bacterial creams like Eberconazole Topical – 1%, Fusidic Acid,Sertaconazole Topical – 2% W/W after using them the rashes still comes and goes . I had one small rash on my genital last week and with slight pain without any medicine it got cleared now after 9 days ..I went to urologist and showed him the rash he said it just normal and nothing like an infection . He said me to consult a general physician for the increased lymphocytes . is there any test i can run on my blood to zero in on the viral infections which is causing me High Lymphocytes ..

    Reply
    1. Buddy M.D. Post author

      Counts increase in viral infections. This increase would normalize on their own with time. Interventions are not recommended.

      Reply
      1. sandeep

        My Lymphocytes are above 40 % for more than 18 months now it is above 55 % for the last 3 months which is Lymphocytosis as per the blood report , i am just worried did my CMV IGG positive is causing this high lymphocytes ..Or is there a chance i have bacteria infection which might be causing this high lymphocytes …

        Reply
        1. Buddy M.D. Post author

          Bacterial infections may give you fever, malaise. There would also be an increase in neutrophil counts.

          This is likely to be due to some virus.

          Reply
          1. sandeep

            My neutrophil count is below the normal level of 40 % and my lymphocytes is above 57 % is it possible that such high count is only possible with Viral infection . I had chicken pox 12 years ago is there any chance my virus got reactivated again and causing these high lymphocytes

            PCV : 40.5 % below Normal Range of 42 %
            MCHC : 37.8% Above Normal Range of 32-36
            Absolute Lymphocyte Count : 3135/c.mm Above Normal Range of 1000-3000
            Absolute Monocyte Count : 165/c.mm Below Normal Range of 200-1000
            Absolute Basophil Count : 0/c.mm Below normal Range of 20-100
            Lymphocytes 57 % Above Normal Range of 20-40
            Neutrophils Count : 38 % below Normal Range of 40-80
            MPV 9.8 fl above normal range of 6-9.5

  11. abc

    From four days i have fever in range of 103 – 104 woth wbc count 3300, dengue/maleria/typhoid tests are negative….what may be the reason??

    Reply
    1. Buddy M.D. Post author

      Likely to be viral infection, with these low values of WBCs. Take adequate rest. Drink plenty of water to avoid dehydration. High fever states may dehydrate the body.

      Eat healthy.

      If you have any other symptom, else fever, do let us know.

      Reply
  12. divya

    My mother having platlet count 110 and TLC 3.6
    Is it a sign of dengue or it’s a viral fever. Though the temperature is going up to 101 and down to 98. What medication should we takee. Malria typofa test are necative

    Reply
      1. Buddy M.D. Post author

        Likely to be viral. However, if you’re staying at a place where dengue is prevalent, a dengue screening may be done.

        Reply

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