Numerous blood draws and mysteriously low neutrophils

Species: Cat Age: 7 Sex/Neuter status: Female - neutered Breed: American shorthair, domestic. Body weight: 10-12lbs   Adopted cat as a kitten - was a barn cat. Indoor only. One dog sibling. Little-no health concerns, but did have a 'cold' in early October. This resolved with time. At that time vet suspected feline herpes, but no further tests. Before blood draws/vet visits she is given 300mg gabapentin. Was on fluoxetine for anxiety and that was the reason for original blood panel. Did 2 blood panels and both came back with extremely low neutrophils. Did a 'fever of unknown origin' panel - all came back negative. Imaging - revealed enlarged spleen and potentially liver, but vet thought enlarged spleen could be due to stress (again, very anxious kitty). Did 2-week antibiotic trial in case testing didn't pick up on something - neutrophils still low after that trial. Weened off of fluoxetine, in case that was a random cause - did this over 2-weeks and waiting a month after for follow-up blood draw and panel. Got the results back today and neutrophils, among another things, are off. I've attached the latest bloodwork results and appreciate any insight things to follow-up with my vet on. Overall, she remains a (surface level) healthy kitty. She eats and drinks normal. Got her a water fountain after original lab work, which also showed mild kidney concerns - hard to know if she's drinking more for health or if the fountain is enticing. Energy and interests are the same. Nothing of note in the litter box department. We were gone for the weekend and she did have a few hairballs - I'm guessing this is stress related, especially in the absence of fluoxetine. Vet recommended next step be internal medicine to get a bone marrow draw and potential aspirate of the spleen. In the meantime she also recommended another antibiotic trial. Thank you

Hello!   It sounds as though the patient isn't ill - as in, no clinical signs at the moment? - Does your vet agree?  And what your vet wants to know is, why are the white blood cells low and albumen high? I dont know enough about this case to comment.  Questions in my head are:  could this have been a machine error?  What does the blood smear look like?  Did they look at one? What size are the neutrophils that are present?  Might they be measuring low because they clumped together in the tube? Is there anything notable about their appearance? What are their nuclei like and what does that tell us? I notice the name of a laboratory on the sheet - that laboratory does sometimes have excellent support from pathologists.  Pathologists tend to sit in offices looking at cells for long periods of their day and in my experience, love it when a vet calls up to chat the situation through, in case they are missing something.  It lets them use their considerable knowledge and put the sample into context of a case.  Even if the sample was run on an in-house vets machine, they will be happy to explain what services their laboraory can provide next - its good for business.  Veterinary training is often provided by big labs such as this one. Pathology was never my favourite subject at college so I have spent happy minutes on the phone to lab pathologists.  I must admit to never having heard one say that it's a good idea to give consecutive antibiotics trials - these are firmly out of favour in the Uk because of antibiotic resistance (see our blog on the subject).   If I dont know what Im trying to kill, where, I cant choose the right antibiotic. However, please remember that I dont know anything about the case in question - remember that I have never seen this patient - but it might be useful to double check with a pathologist, 'Is treating this with antibiotics a good idea?'  I dont think that much would be lost as a result of this phone call and a second opinion may help to lead the case down new avenues or put your mind at rest.  

Generally speaking, sometimes neurophils go low because the bone marrow isnt producing them, which would be serious, but sometimes its a lab error.