Question: Hi, I have 2 years old son. Recently we noticed that his palm and face were looking yellow to us. upon online consultation we have him checked for CBC and LFT. In his reports his AST ALT ratio is exceptionally high 2.67 and his whole WBC panel is low. I am uploading his reports . He doesn't have any other symptoms which we can notice. One time his mother notices one nodes like at his neck but which also is not very visible all times. His eyes are white. kindly provide reply in details . 1. What are the reasons for his AST/ALT ratio 2. What are the reasons for his low WBC panel TLC is 3.90 (range is 4 to 15) RBC is 6. 27 neutrophills are 0.34 only ((1.5 to 8) Lymphocytes are 3.39 (6 - 9) monocytes 0.17 (.2 to 1) eosinophills and basophills are zero. His platelates are 368. Kindly provide reply in detials, U an thalassamia minor by the way.
Although AST ALT in range but AST is touching upper border and APT being lower than AST, is it ok, because yellowness is there in body. Not only palm and feets but I can see body also kind of pale or yellow, therefore I was worried about this ratio reversal. Such ratio is reported every where associated liver serious diseases. How comforting are these reports with respect to that. And WBC being low is another worry for me, because it's being reported with serious disease like home marrow suppression, leukemia etc. Is neutropenia normal without these serious diseases too, like with viral fever or something. Because there are no sign of viral infection of any type. His breathe is giving kind of fruity smell , I have observed even after brushing, and when exhaling too. Can this be related. What test would you suggest ? And what possible causes for yellowish discoloration as per your opinion. He is fit and fine otherwise, no other symptoms appears to us, so this sudden rapid kind of discoloration we observed in last 6 days made me worried, and his low WBC also, whether he is prone to infection with such low neutrophils. As in his case his numbers are in severe neutropenia, which again is reported with serious diseases. Sorry for asking again, but please give detailed reply. Thanks and Regards.
Hi, doctor my queries are still unanswered, I am worried about present trend, and will come back after repeated test. But first you said that ratio is not an issue as AST ALT values are in their individual range, but here in your reply second time, you have said it's warning sign. Both are kind of opposite, sorry for asking that, but if you find this report worrisome for any reason please tell in details so that actual worry can be found out. I have asked about infection prone due to severe neutropenia, and any precautions we might need to take, is unanswered? and is it any way connected with possibility of leukemia or any serious disease. Have you seen any cases with such neutropenia due to other reasons too. Which blood test we need to go for for clearing out doubts@
Last query , I afraid for leukemia and liver cirrocis, how safe we are from your point of view with present report only. Thanks and Regards.

Hi, I have 2 years old son. Recently we noticed that his palm and face were looking yellow to us. upon online consultation we have him checked for CBC and LFT. In his reports his AST ALT ratio is exceptionally high 2.67 and his whole WBC panel is low. I am uploading his reports . He doesn't have any other symptoms which we can notice. One time his mother notices one nodes like at his neck but which also is not very visible all times. His eyes are white. kindly provide reply in details . 1. What are the reasons for his AST/ALT ratio 2. What are the reasons for his low WBC panel TLC is 3.90 (range is 4 to 15) RBC is 6. 27 neutrophills are 0.34 only ((1.5 to 8) Lymphocytes are 3.39 (6 - 9) monocytes 0.17 (.2 to 1) eosinophills and basophills are zero. His platelates are 368. Kindly provide reply in detials, U an thalassamia minor by the way.
Although AST ALT in range but AST is touching upper border and APT being lower than AST, is it ok, because yellowness is there in body. Not only palm and feets but I can see body also kind of pale or yellow, therefore I was worried about this ratio reversal. Such ratio is reported every where associated liver serious diseases. How comforting are these reports with respect to that. And WBC being low is another worry for me, because it's being reported with serious disease like home marrow suppression, leukemia etc. Is neutropenia normal without these serious diseases too, like with viral fever or something. Because there are no sign of viral infection of any type. His breathe is giving kind of fruity smell , I have observed even after brushing, and when exhaling too. Can this be related. What test would you suggest ? And what possible causes for yellowish discoloration as per your opinion. He is fit and fine otherwise, no other symptoms appears to us, so this sudden rapid kind of discoloration we observed in last 6 days made me worried, and his low WBC also, whether he is prone to infection with such low neutrophils. As in his case his numbers are in severe neutropenia, which again is reported with serious diseases. Sorry for asking again, but please give detailed reply. Thanks and Regards.
Hi, doctor my queries are still unanswered, I am worried about present trend, and will come back after repeated test. But first you said that ratio is not an issue as AST ALT values are in their individual range, but here in your reply second time, you have said it's warning sign. Both are kind of opposite, sorry for asking that, but if you find this report worrisome for any reason please tell in details so that actual worry can be found out. I have asked about infection prone due to severe neutropenia, and any precautions we might need to take, is unanswered? and is it any way connected with possibility of leukemia or any serious disease. Have you seen any cases with such neutropenia due to other reasons too. Which blood test we need to go for for clearing out doubts@
Last query , I afraid for leukemia and liver cirrocis, how safe we are from your point of view with present report only. Thanks and Regards.

Hi, thanks doctor for detailed reply. 1. We have given our baby Hep A vaccination and Hep B vaccination first does, and second dose of Hep B is due only. He doesn't have any symptoms of any viral infection too. Only thing happened that once may be a mosquito or something like bit his on eyelids and hands, and they both got swollen for two days. After giving him cetrazine symptoms came back to normal around 20 days before.I was surprised too why he had strong response to that, His mother also have urticaria, so I thought may be he has same thing. 2. Before lockdown he used to go out daily in garden, and touching every thing, but did not have any issue, was that possible with such neutrophils? Because severe neutrophilia has surprised me. 3. His skin is albeit better than pictures I have posted.He looks better now, but a little yellow when see in our comparison. 4. I uploading his reports again, kindly review his CBC too, although you have done, please review. 5. Taking him to hospital was a blunder, but before going to hospital I inquired from their staff about covid patients admitted there, so they said no. But later on next day on calling some other operator they said they have suspected admitted. So they lied, but only relief is there, upon calling they said , no one is infected, and their reports are normal. I followed on papers too, 5 days are past and no news so bit relived. Only thing was bad that for taking his blood out we had to take him emergency room too because he was not at all cooperating due to getting scared, so three persons had to hold him, and touched him too. I tried to put on mask which baby threw twice forcefully. 6. He is in home completely 100 percent, except hospital visit. With this neutrophiles, we are trying best to not let him touch him unnecessarily. How safe is home, means any precautions additionally, although you have given details. Thanks for that. 7. In last after going through blood report , your opinion about reverse ratio and severe neutrophile, sorry for asking again I am worried leukemia or cirrhosis like dreaded diseases. Thanks and Regards

Hi, thanks doctor for detailed reply. 1. We have given our baby Hep A vaccination and Hep B vaccination first does, and second dose of Hep B is due only. He doesn't have any symptoms of any viral infection too. Only thing happened that once may be a mosquito or something like bit his on eyelids and hands, and they both got swollen for two days. After giving him cetrazine symptoms came back to normal around 20 days before.I was surprised too why he had strong response to that, His mother also have urticaria, so I thought may be he has same thing. 2. Before lockdown he used to go out daily in garden, and touching every thing, but did not have any issue, was that possible with such neutrophils? Because severe neutrophilia has surprised me. 3. His skin is albeit better than pictures I have posted.He looks better now, but a little yellow when see in our comparison. 4. I uploading his reports again, kindly review his CBC too, although you have done, please review. 5. Taking him to hospital was a blunder, but before going to hospital I inquired from their staff about covid patients admitted there, so they said no. But later on next day on calling some other operator they said they have suspected admitted. So they lied, but only relief is there, upon calling they said , no one is infected, and their reports are normal. I followed on papers too, 5 days are past and no news so bit relived. Only thing was bad that for taking his blood out we had to take him emergency room too because he was not at all cooperating due to getting scared, so three persons had to hold him, and touched him too. I tried to put on mask which baby threw twice forcefully. 6. He is in home completely 100 percent, except hospital visit. With this neutrophiles, we are trying best to not let him touch him unnecessarily. How safe is home, means any precautions additionally, although you have given details. Thanks for that. 7. In last after going through blood report , your opinion about reverse ratio and severe neutrophile, sorry for asking again I am worried leukemia or cirrhosis like dreaded diseases. Thanks and Regards