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.

he has been vaccinated for Hep A and Hep B. I did not find any viral symptoms in him so far, totally healthy. Skin color is normal when not seen relative but obvious looks yellow when looked . I am mainly concerned about leukemia or any other liver related serious issue. His pictures are appearing extra yellow but doesnot look yellow that much in day time.

Hi, doctor, due to restriction I could not get His ultrasound, and will have it tomorrow. His repeated CBC, LFT and KFT report are attached. Blood smear is also done but I haven't got it yet but they have said it's normal as per them . Neutrophiles are now in range and value are 4.2 (not extremely low as in old report 2hich was 0.34), but lymphocytes are 58 percentage, and absolute value is 6.7. Lab person told me that for child range are different and doctor knows, they will tell better. AST ALT ratio is now standing at around 2. His bilirubin and rest values are in range and not has risen as earlier were suspected. 1 . What is possibility of leukemia, as per your experience, because lab people told me children has different range and values are fine, yet it doesn't match with their reference. As per them his smear test report is normal. 2. AST AND ALT ratio is high still, lesser than 2.67 now it's 2.0 , AST XXXXXXX 5 or 6 figure. His yellowness of skin is improved for sure. 3 He has higher value of blood urea too. Thanks and Regards

Which specialist?

Here are following reports. I have asked same reply from gastrointestinal, Dr XXXXXXX on healthcare magic. He was more concerned about neutrophilia, which is not the case now. And please in detail mention what do you mean by hepatorenal involvement. We had his ultrasound around 1 year before, that time it was normal.