Brief Answer:
Raised alkaline phosphatase may be due to vit D deficiency

Detailed Answer:
Hello

Thanks for the query.There can be so many causes of poor weight gain.

Some common causes are poor nutritional intake,poor absorption due to some chronic intestinal disease,any systemic disease involving heart/kidney,repeated infections,frequent diarrhea and hormonal causes(Juvenile diabetes,thyrotoxicosis).

Does he have any symptom like low grade fever,frequent loose stools,increased thirst,increased frequency of urination,excessive sweating or frequent respiratory problems ?

Common causes of increased alkaline phosphatase are liver disorder or Vit D deficiency.
As liver function test showed only raised alkaline phosphatase and other parameters like SGPT/SGOT and serum bilirubin are normal,liver dysfuction has been ruled out.

Vit D deficiency is mostly due to decreased intake in food containing vit D and poor exposure to sun. Vit D deficiency is also one of the cause of poor growth.

Reactive thrombocytosis can be due to secondary to disorder like infection,iron deficiency,few chronic disorder or some other uncommon causes.
Iron deficiency is very common in pediatric age group.
In presence of thrombocytosis and raised alkaline phosphatase iron deficiency must be kept as a differential diagnosis.As both iron and vit D deficiency are mainly due to nutritional deficiency and both of these are associated with poor growth.
I would request you to attach the reports so that I correlate these.Please mention the present weight and height if possible.

Serum vitamin D level,X ray of both wrist,serum calcium level and iron profile can give a clue.

Waiting for your reply.
Regards

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Brief Answer:
Chance of iron deficiency is very less

Detailed Answer:
Hello

I have gone through the reports. The peripheral smear showing normocytic normochromic picture and hemoglobin is 12.5,so this is not suggestive of iron deficiency.

A repeat hemogram after few days may be needed to check wheather thrombocytosis is resolving or not.

For raised alk. phosphatase please consult your pediatrician for evaluation of vi D deficiency(rickets) if it is needed.

Regards

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Brief Answer:
Vitamin D level is low

Detailed Answer:
Hello

Serum vitamin D level is below the normal limit. The management of Vit D deficiency depends on the severity of bony changes.
If there are significant bony changes suggestive of rickets then Stoss therapy is needed(6 Lac unit IM stat).
If bony changes are not significant and only vitamin D deficiency is there, then 60000 unit/week for 10 weeks is needed.

As Xray causes radiation hazard I prefer to do Vitamin D test first and if it comes low then suggest for Xray wrist for management.
As Vitamin D level of your child is low I would suggest you to get an Xray wrist done after consulting your pediatrician as this will help in making decision regarding management.

According to XXXXXXX academy of pediatrics the weight of your child is below the 50th centile(it is 25th centile). Weight below 50th centile is low and below 3rd is very low.The growth should be monitored under various parameters like weight,height,body weight and parents height. Growth recorded at interval is more accurate than recorded at a single time. So I would also suggest you to follow the growth chart (available on the net) with the help of your pediatrician.

Will be glad to answer if you have any concern.
Regards

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