Dear Dr. Roach: For the second time in two years, I’ve had bloodwork done due to massive headache, general tiredness and body pains. Both times, I also had very minor signs of a cold (post-nasal drip). My recent test shows elevated neutrophils of 89 percent (normal range is 40-80 percent), with high normal absolute neutrophils. My lymphocytes are more concerning, at 4 percent lymphocytes (range 20-40 percent), with absolute lymphocytes of 272 (range 1,000-3,000).

I’m having recurrent low-grade fevers (99.6-100.3) that seem to last only a few hours; night sweats; and am generally exhausted all the time. I am currently in a tropical country, and am concerned at times about the care I receive here.

What follow-up care, if any, should I request, and with what kind of doctor? I am concerned about lymphoma, as both my mom and brother have had it. — M.H.

Answer: It is difficult to evaluate your blood counts, as both times you had it done, you were sick. A complete blood count (CBC) in a person who is sick with an acute infection often shows elevated neutrophils and low lymphocytes, so I would recommend evaluation during a time when you are well, if possible. A hematologist is the expert in reviewing results of white blood cell (as well as red blood cell and platelet) abnormalities.

Lymphoma can cause fevers and fatigue, so it is a diagnosis that is worth considering, especially with your family history. However, being in a tropical country, you are at risk for many different infections, which may have very similar symptoms and are far more likely. If you are concerned that your regular doctor lacks the expertise, you might consider an expert in infectious diseases to help evaluate your current situation. A local expert certainly will know what is common where you are.