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Child's lab shows suspicious ESR and C-reactive protein level. Opinion?

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Hi, I have a questions in regards to my son blood test results. The Doctor reviewed and said all is fine.
I have a concern for his ESR level = 19, he has 4 years and 6 months. C reactive protein is normal at 0.12. He had several upper respiratory infections during the winter, inflammed tonsils which required antibiotics, several colds and coughing during this winter/early spring season.
We live in New York. As a result of his most recent infection (tonsils/upper respiratory) it appreared an enlarged lymp node on the left side of neck. It is soft, move around and has shrank, but it is still there....for over 6 weeks. But for sure it has decrease in size, and as per Dr. it is very soft and ant attached to any structure. Dr. said no need for concern.
But, as a mother, I just want to be extra cautious. What would be your opinion about his ESR = 19 and C Reactive protein at 0.12 levels ??? CBC with auto diff is normal.
Thank you very much.
Mrs.XXXXXX
Posted Thu, 6 Jun 2013 in Child Health
 
 
Answered by Dr. Imraan Hussain 34 minutes later
Hi,

Thanks for your query

I can feel your concerns.

ESR is a nonspecific marker of chronic (old) infections whereas CRP signifies a new onset of infection. A raised ESR means the infective process is going on for a longer period of time , as tonsillitis and recurrent respiratory tract infections.
And CRP denotes that recently he has not any acute infection.

Children with tonsillits and adenoiditis usually present with disturbed sleep and night time awakening episodes.

1. Is there any history of fever this time?
2. Is there any history of recent weight gain or weight lost?
3. is there any History of allergy?
4. Is there any history of worm infestation?

Waiting for your follow up.
If you have any other query?

Wishing him a speedy recovery.
Regards,
Dr. XXXXXXX Hussain


Above answer was peer-reviewed by
 
Follow-up: Child's lab shows suspicious ESR and C-reactive protein level. Opinion? 5 days later
DR. XXXXXXX

Thank you very much for your response.

Answering your questions:
1. Is there any history of fever this time? NO. He had fever for just one day when had acute infection in throat/tonsils (102o.F).
Managed fever with Tylenol and Motrin.

2. Is there any history of recent weight gain or weight lost? No, he lost 1 pound since November last year , but now gained again, and is back to normal. He is now 41 pounds and he is 4 years and 6 months old.
3. is there any History of allergy? mild to mold, seasonal allergy due to weather changes, polen, always affecting his upper respiratury system. No need for medication. He sneezes, has runny nose, cough.
4. Is there any history of worm infestation? to the best of our knowledge, NO.
How would I know that? Is there a way to check?

My follow up questions:
A- Why the lymph node still did not get back to normal size? It has swollen a lot during acute infection, then after taking antibiotics for 10 days, got better and shrank a little, but not to the normal size yet. It is located on the left side of neck. His pediatrician said it is soft, and moves around easily. It has been there for over 6 weeks ! Is this normal considering the whole picture/history?

B- The ESR - you explained very well that it is related to an old infection.
Does this mean that the infection is still going on since the level is elevated at 19 ?? OR Doesit mean that the infection may be over, but it will take a while until the level returns to normal range ? Remeber, his C protein level is normal and other blood results are normal too.
Is the elevated ESR a reson for concern? His pediatrician told me not to worry about it, and did not ask for a follow up blood test.

My son is eating and feeling weel. Acting normal, active.

C- If I decide to go to a specialist ,what type of Doctor should I go? He has a very good ENT in Manhattan. Should I consult with her as well based on his history of croup, upper respiratory infections, now the lymp node .....

Again, his pediatrician told me that she does not see a need to consult with a specialist. SHe has been my son's doctor since he was born and knows him very well.

Thank you again. I am looking forward to hear from you.
Regards.
Mrs. XXXXXX
 
 
Answered by Dr. Imraan Hussain 10 hours later
Hi Vlacerda

thanks for such a detailed description.

Worms infestation can be confirmed by seeing the worms in stools or do microscopy on stool examination, children with allergic disorders do have this problem.

If the lymph node size is less than one centimeter than nothing to worry about it is normal size and it goes on changing it according to the immune status.

One other reason for rise in ESR is anaemia also, ESR will take time to return to normal level , you can repeat it in a one week period.

you can seek consultancy from an ENT doctor.

Do avoid allergens and one promising method is put some olive oil in the nostrils thrice a day and use green tea along with some honey

Your doctor will tell you about a medicine montelukast to be used in this condition.
If you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health".

regards
Dr. XXXXXXX Hussain
Above answer was peer-reviewed by
 
Follow-up: Child's lab shows suspicious ESR and C-reactive protein level. Opinion? 13 hours later
Thank you for your responses.
I just need clarification on the following :questions A, B, C ,D below.

-Do avoid allergens and one promising method is put some olive oil in the nostrils thrice a day and use green tea along with some honey -
a) how should I put the olive oil in the nostrils? With cotton swab?
b)The green tea/honey is to drink or also to put a few drops in the nostrils?


Your doctor will tell you about a medicine montelukast to be used in this condition.
c) Which condition exactly you are referring to: allergy ,upper respiratory, the enlarged lymph node???

D) You also mention that elevated ESR could be anaemia. His red & white blood count are at normal levels. Is this enough to assure that he is not with anaemia?
 
 
Answered by Dr. Imraan Hussain 41 minutes later
Hi,

Thanks for your query

1. For better effectiveness olive oil need to be layered inside the nostril. You may use a gloved little finger to layer it gently. The oil layer acts as a protection and will not allow pollen and dust particle to illicit allergic reaction.

2. And of course green tea and honey are to be taken orally

3. Montelukast is taken as a prophylactic drug for allergic disorders and your child is getting respiratory tract problems due to allergies.

4. Yes, if RBC count is normal then the cause of raised ESR is chronic respiratory problem. Nothing to worry about it, it will settle on its own

If you do not have any clarifications, you can close the discussion and rate the answer.

Wish your child good health.

Regards
Dr. XXXXXXX Hussain
Above answer was peer-reviewed by
 
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