DEAR DR. ROACH: I am a female and almost 75 years old. My vital signs are always normal, and I am active, but slightly overweight. I get quarterly blood draws, and every reading is in the normal range except for the lymphocytes. That count is higher, just outside the normal range (the lab’s range is 850 to 3,900 cells/uL, and my absolute lymphocytes are 4,377 cells/uL).

This has occurred in the blood draws from the last two or three years, with the exception of one that was back in the normal range. About 12 years ago, after several abnormal results, I saw a hematologist, who reported nothing wrong after doing more extensive blood work. No reason could be given for it. I am concerned, but not obsessing over it. Is there any reason you can give for the slightly high lymphocyte count? — S.M.

ANSWER: Lymphocytes are one of the two major types of white blood cells found in the blood (the other are the granulocytes, the most common of which are the neutrophils). High levels of lymphocytes raise suspicion for serious blood disorders such as some leukemias, lymphomas and related blood diseases, but there are other causes. Acute stress can do it, but you have been living with this for many years. Not having a spleen causes high levels of lymphocytes, whether you are born without one or have it surgically removed. Chronic infection is another reason.

I suspect your hematologist did a more sophisticated set of tests looking for blood disorders, and the fact that your level is the same after 12 years also supports my suspicion that this level is normal for you. Normal levels are generally defined as what is found in people without evidence of disease 95 percent of the time. So, by definition, 5 percent of normal people will have their result on any given lab fall outside of the normal range. Since yours is just outside of the normal range and, as I said, unchanged for years, I think you can relax your level of anxiety. Periodic blood tests do seem prudent, however, and further testing would be recommended in the event that the count starts getting higher or you develop any new symptoms.

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DEAR DR. ROACH: I am a 67-year-old male in relatively good health. I exercise regularly (four times a week). I have been taking medication for hypertension, which is getting much better since I started a plant-based diet three months ago.

About every three months or so for the last five years, there are two half-dollar-sized blood stains on my pillow coming from my right ear. I have no headaches, and my hearing is what it is for my age. My wife is concerned, but I am not. What do you think? — J.G.

ANSWER: I think your wife is wise to be concerned. This is not something I commonly encounter, and the answer is very likely to be found inside your ear through a clinical exam. I do sometimes see small infections in the ear that may bleed, and there are benign tumors of the ear canal and eardrum that may sometimes bleed as well. I have read about a very rare condition of an aneurysm bleeding from the ear. This has been going on a long time, so it’s definitely worth an evaluation.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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