### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
white blood count went from 3.3 to 3.0 (range 4.5-11)red blood count went from 4.46 to 4.36 (range 4.5-5.5)HGB and HCT normalMCV went from 96.9 to 100.4 high normal (83-101)MCH went from 33 to 32.9 high normal (27-34)MCHC went from 34.1 to 32.8 low normal (31.5-36)RDW went from 12 to 12.2 (11.5-14.5)Platelet went from 228 to 209 low normal (150-400)Neutrophils went from 1 to 1.1 low and from 30% to 31% Bands from 1% to 4%Lymphocytes went from 1.9 to 1.5 and from 59% to 51%monocytes from .2 to .3 and from 6% to 10%Eosinophils from less than .1 to .1 and from 3% to 4%Basophils tested on first test as less than .1 and 1% Having joint and muscle pain, pain in back. legs shoulders it migrates.  Chills/sweats, rapid change in vision, shakes in hands, cramping in feet, mood swings, fatigue and sleep disturbances.  Being referred to oncologist at cancer center, what could the causes for my decreased cbc and symptoms be?

### output:

Hi, Thanks for asking. Based on your query, my opinion is as follows.1. It appears you are possibly having megaloblastic anemia. It B12 deficiency commonly leads to increased MCV, anemia and leukemia.2. It B12 serum assay will confirm it. Multiple systemic symptoms suggest nutritional deficiency rather than oncology problem.3. However, do get a bone marrow biopsy done to rule out any malignancies in blood. Hope it helps. Any further queries, happy to help again.