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Lack Of Immunity, Blood Test Done, High Eosinophils, Low Hemoglobin Levels. Leukemia, Neutropenia Or Lymphoma ?
Question: My daughter is 29 days old and she suffers of the lack of immunity on her body as her doctor's says. Her doctor still can't tell exactly if she has Lukemia, Neutropenia or Lymphoma. This blood test was take two days ago :
test name/ result/ unit / refrance
Eosinophils/0.45/#/0-0.1
Monocytes/0.81/#/0.2-0.8
Lymphocytes/7.61/#/1.5-4
Neutrophils/0.49/#/2-7.5
Neutrophils/5.3/%/40-75
Platelet/440/10^9/140-350
Red Cell Distribution Width/18.4/%/11.5-16
Mean Cell Hemoglobin/22.8/pg/27-32
Mean Cell Volume/68.3/fl/80-97
Hematocrit/29.1/%/36-44
Hemoglobin/9.7/gm,dl/11-14
Please, help me. Many Thanks.
test name/ result/ unit / refrance
Eosinophils/0.45/#/0-0.1
Monocytes/0.81/#/0.2-0.8
Lymphocytes/7.61/#/1.5-4
Neutrophils/0.49/#/2-7.5
Neutrophils/5.3/%/40-75
Platelet/440/10^9/140-350
Red Cell Distribution Width/18.4/%/11.5-16
Mean Cell Hemoglobin/22.8/pg/27-32
Mean Cell Volume/68.3/fl/80-97
Hematocrit/29.1/%/36-44
Hemoglobin/9.7/gm,dl/11-14
Please, help me. Many Thanks.
Hello and thanks for the query.
Your question is a good one and i will work on providing some good information and recommendations regarding what is going on.
My first question to you regarding your daughter is - were there any complications of the pregnancy? Was it a full term delivery? Was your wife needing to take any medications at the time of delivery?
At this point it may be too early to tell what the exact problem is due to the fact that the immune system and blood cell production (bone marrow) is quite young at this time and may in fact take a bit of time to fully generate the normal cells including white blood cells, platelets and red blood cells.
On review of the labs you submitted - platelet count is fine - only mildly elevated which is not much of a concern here, while hemoglobin is low and I do not see the total WBC count. I do see that the total neutrophil count is low which is of course a concern. If you could check the lab result again and let me know the total white blood cell count this will be helpful in putting together an idea of what is going on.
I realize this is a very stressful time for you but let me reassure you that I will do my best to correlate all of the information you provide with a good clinical impression of what is going on.
I await the additional information from you.
I thank you again for the query and hope my response serves to be helpful and informative. Should you have additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Your question is a good one and i will work on providing some good information and recommendations regarding what is going on.
My first question to you regarding your daughter is - were there any complications of the pregnancy? Was it a full term delivery? Was your wife needing to take any medications at the time of delivery?
At this point it may be too early to tell what the exact problem is due to the fact that the immune system and blood cell production (bone marrow) is quite young at this time and may in fact take a bit of time to fully generate the normal cells including white blood cells, platelets and red blood cells.
On review of the labs you submitted - platelet count is fine - only mildly elevated which is not much of a concern here, while hemoglobin is low and I do not see the total WBC count. I do see that the total neutrophil count is low which is of course a concern. If you could check the lab result again and let me know the total white blood cell count this will be helpful in putting together an idea of what is going on.
I realize this is a very stressful time for you but let me reassure you that I will do my best to correlate all of the information you provide with a good clinical impression of what is going on.
I await the additional information from you.
I thank you again for the query and hope my response serves to be helpful and informative. Should you have additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Radhika
She was born at 38 weeks gestational age on 21st Oct 2011. Apgar scores were 7 at one minute and 9 at five minutes. Routine care was given. She was appropriate for gestational age with no dysmorphic features seen.
Her mother's blood type is A positive and infant's blood type is B positive. The baby did not receive any phototherapy.
This is the medical report.
She was admitted to the NICU on the 21st Oct 2011 having the following problems.
Respiratory Distress Syndrome/Bronchopulmonary Dysplasia:
Respiratory wise, She was on room air with mild respiratory distress. The baby is having mild tachypnea otherwise.
Apnea of Prematurity:
Not applicable for this baby.
Patent Ductus Arteroisus/ Cardiovascular Anomalies:
Not applicable for this baby as CVS with normal heart sound and no murmur. Baby was hemodynamically Stable.
Hematology:
CBC on 21st Oct 2011 showed a hemoglobin of 12.6, WBC of 12-18, Platelet count of 252,000, Neutrophils count results 1.9 to 0.0 to 1.15 to 1.55 to 0.66 to 0.77 and no left shift.
Sepsis:
The infant received a 10-day course of Ampicillin and Gentamicin. The infant had a full septic workup during stay in NICU. Urine, blood CSF, cultures are nefative. CRP 69 to 67 to 23 to 22 to 13.02
Neurological:
The infant has behaved appropriately for gestational age.
Fluids, Electrolytes and Nutrition:
The baby is tolerating full feeds. During stay, wlwctrolytes are normal. Calcium and magnesium are normal.
Immunizations:
1-BCG. 2-Hepatitis B Vaccivation.
Discharge Medications:
Vitamin D3 400 IU o.do x30 days.
Neonatal Screens:
Thyroid screen was completely normal.
Referral and follow-up:
The baby was referred to Pediatric Hematologist.
Please, guide me. I can provide you with all the tests results and even can do new ones if necessary. Thank you so much, Doctor XXXXXXX
Her mother's blood type is A positive and infant's blood type is B positive. The baby did not receive any phototherapy.
This is the medical report.
She was admitted to the NICU on the 21st Oct 2011 having the following problems.
Respiratory Distress Syndrome/Bronchopulmonary Dysplasia:
Respiratory wise, She was on room air with mild respiratory distress. The baby is having mild tachypnea otherwise.
Apnea of Prematurity:
Not applicable for this baby.
Patent Ductus Arteroisus/ Cardiovascular Anomalies:
Not applicable for this baby as CVS with normal heart sound and no murmur. Baby was hemodynamically Stable.
Hematology:
CBC on 21st Oct 2011 showed a hemoglobin of 12.6, WBC of 12-18, Platelet count of 252,000, Neutrophils count results 1.9 to 0.0 to 1.15 to 1.55 to 0.66 to 0.77 and no left shift.
Sepsis:
The infant received a 10-day course of Ampicillin and Gentamicin. The infant had a full septic workup during stay in NICU. Urine, blood CSF, cultures are nefative. CRP 69 to 67 to 23 to 22 to 13.02
Neurological:
The infant has behaved appropriately for gestational age.
Fluids, Electrolytes and Nutrition:
The baby is tolerating full feeds. During stay, wlwctrolytes are normal. Calcium and magnesium are normal.
Immunizations:
1-BCG. 2-Hepatitis B Vaccivation.
Discharge Medications:
Vitamin D3 400 IU o.do x30 days.
Neonatal Screens:
Thyroid screen was completely normal.
Referral and follow-up:
The baby was referred to Pediatric Hematologist.
Please, guide me. I can provide you with all the tests results and even can do new ones if necessary. Thank you so much, Doctor XXXXXXX
Hello again and thanks for that thorough summary of the hospitalization.
At this time I am not convinced that there is a primary bone marrow disorder going on.
There are several things which can lower or depress blood counts including neutrophils and these include viruses. Some viruses are difficult to detect in common screening assays and include variants of parvovirus or influenza virus among others.
From the discharge summary you provided it looks like she received appropriate care including a very thorough infectious disease workup and antibiotic therapy which would generally cover the bacteria which can cause sepsis in a young child.
Right now it will be most important to gather serial CBC data to evaluate for any fluctuation in the blood counts and also hopefully for a resolution of the low iron levels.
I like the trend I see in the CRP which can be a marker of infection, inflammation or both. It is trending downward to a normal level which leads me to suspect some type of infectious or inflammatory issue which played a role in all of this.
I am sure this experience is overwhelming for you to say the least. Let me reassure you that I am here and will be here to review any additional data you can provide. Specifically I am interested to see the next CBC result which I would expect to be drawn within the next 7 to 10 days.
There are excellent hematologists in your country so I am relieved to know that you will likely be getting good specialty care.
Right now again I do not see obvious evidence of leukemia or lymphoma or bone marrow failure. Continue to support the baby with adequate feedings, good love and affection and continued followup as scheduled with the specialist.
Again I am happy to continue exchanging information and my impression with you and await any followup you may provide as we continue to support the good health of your baby.
Sincerely,
Dr. Galamaga
At this time I am not convinced that there is a primary bone marrow disorder going on.
There are several things which can lower or depress blood counts including neutrophils and these include viruses. Some viruses are difficult to detect in common screening assays and include variants of parvovirus or influenza virus among others.
From the discharge summary you provided it looks like she received appropriate care including a very thorough infectious disease workup and antibiotic therapy which would generally cover the bacteria which can cause sepsis in a young child.
Right now it will be most important to gather serial CBC data to evaluate for any fluctuation in the blood counts and also hopefully for a resolution of the low iron levels.
I like the trend I see in the CRP which can be a marker of infection, inflammation or both. It is trending downward to a normal level which leads me to suspect some type of infectious or inflammatory issue which played a role in all of this.
I am sure this experience is overwhelming for you to say the least. Let me reassure you that I am here and will be here to review any additional data you can provide. Specifically I am interested to see the next CBC result which I would expect to be drawn within the next 7 to 10 days.
There are excellent hematologists in your country so I am relieved to know that you will likely be getting good specialty care.
Right now again I do not see obvious evidence of leukemia or lymphoma or bone marrow failure. Continue to support the baby with adequate feedings, good love and affection and continued followup as scheduled with the specialist.
Again I am happy to continue exchanging information and my impression with you and await any followup you may provide as we continue to support the good health of your baby.
Sincerely,
Dr. Galamaga
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Above answer was peer-reviewed by :
Dr. Raju A.T
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