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18 months child is pale in colour and sleepy. Had stent put in tear duct. Blood work done. Any complication?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
My child is 18 months old went for her check up and blood was drawn. Report of neutrophils 28.7 and lymphocytes64.4. The child really hasn't been sick. The child is some what pale and is active but does require more sleep then the other children. Just recently two weeks ago had a tear duct stent put in. Hasn't been around toxins but has been around cats. Has occasional skin rash. The child is not talking yet but doesn't appear to be in any pain. The child seems to be eating fine but had lost two pounds at check up. Has problems with constipation at times. Had a yeast infection about 4 weeks ago and niacin ointment was prescribed. No known cancer in immediate family. Child was second child year and a half difference.
Posted Wed, 29 Aug 2012 in Cancers in Children
Answered by Dr. Hema Yadav 4 hours later
Thanks for posting your query.
In order to be able to guide you more precisely I would like to know the following,
1. Why was blood test done , any fever , sudden weight loss , significant pallor etc?
2. Kindly upload the complete report if feasible or mention the hemoglobin , total WBC count , eosinophils , ESR if done .
3.what is the present weight of the child and what was the birth weight.Has the child achieved developmental milestones like walking , speaking bisyllables ,etc .
4. Is the child allergic to anything or is there a family history of allergy.

The normal range for lymphocytes are 15-40% of White Blood Cells which can increase due to various causes like viral infections , chronic bacterial infections, certain immunological disorders or malignancies .
Increased Relative Lymphocyte Count could be a normal finding in children under age 2 years.
Similarly normally there are more neutrophils 50-60% in blood but they may decrease in above mentioned conditions . The more significant value to know would be your child's absolute neutrophil count or ANC which is a better marker than the percentages of the neutrophils / lymphocytes .
The ANC refers to the total number of neutrophil granulocytes present in the blood. 

Normal value: 1500 cells/mm3.
Mild neutropenia: 1000 - <1500/mm3.
Moderate neutropenia: 500 - <1000/mm3.
Severe neutropenia: < 500/mm3.

Only in case of moderate to severe neutropenia or a mild neutropenia with symptoms like fever, weight loss etc one needs to be concerned and get the child thoroughly investigated by tests like ultrasound , blood smear , viral markers and if required bone marrow studies.
So please do not worry and kindly send me the details so that I can narrow down the probabilities .
Hope I have answered your query.
Awaiting your response,

Above answer was peer-reviewed by
Follow-up: 18 months child is pale in colour and sleepy. Had stent put in tear duct. Blood work done. Any complication? 42 hours later
The child weight at birth was 6 pounds and 15 and 1/2 ounces. She currently weighs 20 pounds. No fever or cold noticed. The blood work was done at her routine check up to check for anemia due to bruises easily and mother is anemic. Mother just had third child in May. The childs blood work shows: basophils 1, eosinophils 1, lymphocyctes 63, monocyte 6, this was on manual differential. CBC with differential was WBC 6.50, RBC 4.18, HGB 11.7, HCT 34.9, mcv 83,5, mch 27.9, mchc 33.3, RDW 12.8, platelets 373, neutrophils 28.7, lymphocytes 64.4, monocyctes 4.6, eosinophils 1.3, basophils 1.1, neutrophil absoulute 1.86, lymphocyte absolute 4.19, monocye absolute 0.30, eosinophil absolute 0.08, basophils absolute 0.07. The child dosen't talk yet, she does try to say words at times. She appears to understand thinks like do you need a drink, pick your toys up, plays with toys and can copy what you do. Very concern about her not talking yet. Her sister was very advanced and singing songs at 18 months. I have contacted birth to 3 years to evaluate her on her talking. She appears to hear what is being said to her and she passed her hearing test when she was born in the hospital. But now concerned as well about the lymphocyctes and monocyctes being off. Father has some allergies to food. Sister has ecezema skin rashes that flair up. The child is a very quiet, loving child. She has became really attached to her new brother. This child is a middle child.
Answered by Dr. Hema Yadav 6 hours later
Thanks for the follow up.
As I suspected there is a relative lymphocytosis in your child which is normal in toddlers and decreases with age. Sometimes even minor allergies or viral infections ( cold, flu) in past may cause increase in lymphocytes .
As of now since your child is asymptomatic , growing appropriately as per weight , and her absolute neutrophil count and lymphocyte count are normal , there is nothing worrisome . In children absolute lymphocyte count may be considered normal till 4.5 to 7. Any value greater than 7 is definitely worrisome and a value greater than 4.5 needs evaluation . Your child's value is 4.19 which would be considered normal .
So please do not worry . If easy bruisabilty is a persistent problem increase her vitamin c intake ( citrus fruits) or get a multivitamin supplement as per doctors advise.
For a assured diagnosis , her blood investigations can be repeated after a certain interval ( 6 months or after 2 yrs of age ) and the results compared.
As of now nothing drastic needs to be done in terms of investigation as well as treatment .
Regarding her speech, remember that every child develops at her own pace and never compare siblings unless very grossly delayed.However it's good that you got her evaluated and it's most probably a physiological lag rather than abnormality. If by 2 years also she is not speaking more words with meaning then you can consult her speech therapist who can help with exercises and teaching techniques.
As of now nothing needs to be done apart from providing her with a loving and stimulating environment , talk to her, sing to her and soon she is likely to speak.
Hope I have answered your query.
Kindly accept my answer if you have no further queries.
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