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Child has ear infection, low neutrophils, high lymphocytes. Not leukemia, bone marrow issues. What tests can be done?

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My 8 month old daughter has low neutrophils (ANC consistently < 150) and high lymphocytes (consistently over 6.0) we have had testing since 9/4/11. We were in the hospital for 1 week and released. Her RBC's are normal (~3.9) and her platelets have ranged within norms (177 to 488). She was screened for multiple viruses and bacterial, with nothing being found. I have seen one specialist in Houston, and he does not think it is Leukemia or bone marrow issues. She has indications of another ear infection, her second since 9/4/11. What tests should we push for to narrow down what is going on? To what extent do we need to keep controlling her environment? Is it ok for the dogs to be around her? What about the cat?
Posted Sun, 29 Apr 2012 in Child Health
Answered by Dr. Robert Galamaga 7 hours later
Hello and thank you for submitting your question.

Your question is a very good one and I will work on providing you with some good information and recommendations regarding what is going on. I also thank you for submitting the blood test results about your daughter for a thorough review with this evening. I took a good look at the values which you provided.

I completely understand the concern you probably have right now and the anxiety it must cause for you. In reviewing the blood tests which you have submitted I would like to comment on a few things. First, as you mentioned it does not appear that she has a primary bone marrow problem going on. Generally if this is the case we would see problems with both hemoglobin and platelet as well as the white blood cells. In her case there is a mild abnormality of the white blood cells which may be just a transient phenomenon.

Sometimes we are not able to find out the actual cause of this but medical technology has afforded us good ways to try to at least look for them. In your daughters case the absolute neutrophil count has been low for quite some time. In considering a possible cost we should consider several different categories including infection autoimmune disorder or bone marrow. As I mentioned previously I do not think there is a problem with her bone marrow regarding this. Sometimes there maybe a viral infection which can cause the destruction of the white blood cells. These viruses are sometimes difficult to test for.

In addition we should consider a possible autoimmune process or maybe some type of allergy. There are several different autoimmune disorders which could cause problems with white blood cells. There are some blood tests that can be order to help list out. I would suggest that you might ask your doctor to consider ordering an XXXXXXX CRP, sedimentation rate, anti-neutrophil antibody screen and possibly a viral panel if it has not already been ordered in the past. If any of these tests come back abnormal we might consider pursuing an autoimmune disorder as a possible cause.

The other category which comes to mind would be allergy. If there is some type of allergy to food or the environment. It may disturb blood counts. This might include allergy to such foods as gluten or possibly to a lesser extent dairy products.

If allergy is a consideration her position could possibly do a blood test or a skin test in order to rule out some type of allergic phenomenon.

Regarding the pets in your house it is possible that there may be some type of allergy related to the animal dander. It might not be a bad idea to consider removing the animals from the home for a couple of weeks to see if this makes any significant impact.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns or additional information which you would like to share with me I would be happy to address them and review it.


Dr. Robert
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