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Child's hemoglobin reduced. On folvite. Further bone marrow study required? Suggest type of food?

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Practicing since : 2002
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Hi I have already uploaded the details of my 7yrs son Dristanta.His hemoglobin was 7.8 on 31/1 and decreased to 7.6 on 10/2/12.serium bilurubin 3.4. Unconjugated bilirubin 3.2 and reticulocyte count 6.0. Current medicine only folvite .5mg.Pl check all the report & suggest me any further bone marrow studies is required? And advise me the the type of food we should continue.And also suggest me the best place in India to do the same if reqd. Thanking You. XXXXXXX
Posted Tue, 8 May 2012 in Blood Disorders
Answered by Dr. Robert Galamaga 14 hours later
Hello and thank you for submitting your question.

Your question is a very good one and I will do my best to book through the data you have provided and work on some recommendations for you.

You have submitted laboratory evidence and a description of a significant degree of anemia in your son. He does have this Beta thalassemia trait but I am not sure that fully explains the degree of anemia that he is experiencing. He also has an elevated bilirubin count which might indicate that there is some destruction of his red blood cells going on.

There are some additional laboratory studies which I would recommend you have performed. The first test would be LDH(Lactate dehydrogenase). This test sometimes is elevated in states where the blood cells are being destroyed. Also a serum haptoglobin level would also be beneficial. This level is often low in cases where red blood self-destruction is going on. if this is the case that there is some destruction of red blood cells it will become necessary to find out where and why this is going on. Sometimes the spleen is activated and can cause destruction of red blood cells. Sometimes we can look for this by doing an ultrasound of the spleen.

Other types of causes of red blood self-destruction include immune problems. If the immune system is activated the patient can sometimes caused instruction of his own red blood cells via antibodies.

Regarding diet it is very important that he maintain a good well-balanced diet with adequate intake of foods which are XXXXXXX in vitamins and minerals. He should also have a very good daily intake of proteins and complex carbohydrates. I assume you're also giving him iron supplementation.

I did not see any bone marrow biopsy report. If he has not had a bone marrow biopsy performed this might also be reasonable to consider to make sure that the factory of his blood cells which is the bone marrow is operating appropriately.

Regarding a local physician or facility where you can have him and I waited I will send your question to our central administration office where we can try to locate some good physicians in your area. We will get back to you regarding that.

I thank you again for submitting your question. I can appreciate that you're dealing with a very stressful situation and I will continue to try to do my best to help you. If you have any additional concerns I would be happy to address them.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Child's hemoglobin reduced. On folvite. Further bone marrow study required? Suggest type of food? 14 hours later
Respected Dr XXXXXXX
Thanks for your nice reply.Sir 1 His LDH already tested on 9/1/2012 at Tata Medical centre Kolkata and found 862. 2.we have already stopped Iron supplement(Livosin)as suggested by Dr XXXXXXX of TMC Kolkata 2/2/2012.His bone marrow studies not yet done.3 Sir what are the probable causes of RBC destruction in his case? Is there any life threatening?.His LFT,Iron saturation &serum total iron are ok.
Thanks & regards
Answered by Dr. Robert Galamaga 13 hours later
Hello and thank you for the follow up question

With LDH elevated this does suggest some degree of destruction of the red blood cells. This can be done by antibodies which are circulating within his body. It is important that his blood cells are looked at by a trained pathologist to look for any abnormalities in what we referred to as the referral smear.

Also if the spleen is activated it can cause a destruction of red blood cells. When this occurs it will also sometimes caused enlargement of the spleen. This can be assessed with an ultrasound or CT scan of the abdomen.

Other disorders such as leukemia should be considered but it does not appear that he has that type of syndrome. I think at some point he should have his bone marrow evaluated. This will give a true idea as to how the blood cells of his body are being generated. If there is a primary problem with the bone marrow then his hematologists can decide if there is some type of intervention that can be performed.

I would not assume that anything is life-threatening at this point. I do think however that it is very important that a full investigation be done in order to evaluate why his blood count is depressed. There are also some viruses which can cause a severe depression of his blood counts. This includes cytomegalovirus which I am sure his doctors have looked for.

I have asked our medical team to look for specialists in your area. They will be in contact with you soon to give you some locations and names of doctors who might be able to help you out.

Again I thank you for submitting your question. I hope you have found my considerations to be helpful. Please let me know if you have additional questions and we can work through this together.


Dr. Robert
Above answer was peer-reviewed by
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