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2 Years Old Diagnosed With Idiopathic Neutropenia. What Are The Standard Test To Be Done?
Question: My 2 yo old was diagnosed with idiopathic neutropenia. My question is what are the standard test to rule out other causes or possible illnesses. She has had her immunoglobulins checked and a both were normal. She is currently on nuepogen injections but continues to have an ANC below 500.Any information is much appreciated.
Hello and thank you for sending your question.
Your question is a very good one and I can appreciate that you are dealing with a stressful situation. I will provide you with some information and recommendations which I hope will be helpful.
Neutropenia as you know can place an individual at a higher risk for developing infections. In the setting of neutropenia there are multiple investigations which can be performed to rule out any primary actually inherited.
It sounds like your daughter has had a very thorough investigation including a bone marrow biopsy. The bone marrow biopsy is a gold standard in helping to diagnose possible causes of this issue.
There are some other tests which might be considered. One test which the doctor might consider would be neutrophil antibodies. This is a special test which might indicate that her body has some type of immune reaction which is causing a decrease in the neutrophils
Under possible consideration would be a referral to a rheumatologist. A rheumatologist specializes in autoimmune diseases. The rheumatologist can also help to consider XXXXXXX pullout possible disorders which might cause a lower white blood cell count. Some of these disorders include rheumatoid arthritis and lupus.
I think it would be advisable for your daughter to have periodic blood counts checked. Sometimes patients with this type of diagnosis can have a predictable cycle where the neutrophil call will drop to below normal.during that stage the doctor might consider supplementation with Neupogen so that the Neupogen does not have to be given continuously.
There are no additional blood test that I would recommend at this time. Again I think your daughter has had a very thorough gemination so far.
Thanks again for sending your question. If you have any additional questions or concerns I would be happy to discuss those with you.
Sincerely,
Dr. Robert
Your question is a very good one and I can appreciate that you are dealing with a stressful situation. I will provide you with some information and recommendations which I hope will be helpful.
Neutropenia as you know can place an individual at a higher risk for developing infections. In the setting of neutropenia there are multiple investigations which can be performed to rule out any primary actually inherited.
It sounds like your daughter has had a very thorough investigation including a bone marrow biopsy. The bone marrow biopsy is a gold standard in helping to diagnose possible causes of this issue.
There are some other tests which might be considered. One test which the doctor might consider would be neutrophil antibodies. This is a special test which might indicate that her body has some type of immune reaction which is causing a decrease in the neutrophils
Under possible consideration would be a referral to a rheumatologist. A rheumatologist specializes in autoimmune diseases. The rheumatologist can also help to consider XXXXXXX pullout possible disorders which might cause a lower white blood cell count. Some of these disorders include rheumatoid arthritis and lupus.
I think it would be advisable for your daughter to have periodic blood counts checked. Sometimes patients with this type of diagnosis can have a predictable cycle where the neutrophil call will drop to below normal.during that stage the doctor might consider supplementation with Neupogen so that the Neupogen does not have to be given continuously.
There are no additional blood test that I would recommend at this time. Again I think your daughter has had a very thorough gemination so far.
Thanks again for sending your question. If you have any additional questions or concerns I would be happy to discuss those with you.
Sincerely,
Dr. Robert
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My husband and I both have a history of autoimmune diseases in our family.He has hoshimotos and I have eosiniphillic gastroenteritis. Is there a blood test you would recommend besides an XXXXXXX and rheumatoid factor?
Sedimentation rate, TSH, free T4, Total T3. An infectious disease workup looking for viruses such as CMV and EBV or parvovirus might also be helpful. If this is a case of primary autoimmune neutropenia it would likely resolve within the next year.
Thanks again for your question. Please let me know if there are any additional concerns you would like to discuss. It is a pleasure to work on helping to obtain more information regarding your daughter.
Dr. Robert
Thanks again for your question. Please let me know if there are any additional concerns you would like to discuss. It is a pleasure to work on helping to obtain more information regarding your daughter.
Dr. Robert
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Your response sent me through both of my childrens lab books where I found a wierd correlation between the two. While my now 17 mo was hospitalized at a month of age she had a low neutrophil count (WBC 7.9 Range 9.5-30*Seg neutro 6 Range 13-33) this was also the first time my oldest child had a staph infection along with a severe ear infection and tonsilitis. My oldest child wasnt diagnosed with idiopathic neutropenia until several months later. My 17 mo was hospitalized for ALTE, severe GER, obstructive sleep apnea, and laryngomalacia. Due to the fundoplication the GER related issues have resolved but she still has elevated SGPT, SGOT, and elevated CPKs. Her last CBC came back as WBC 5.6 range 6.0-17.5 and Segs 39.4 Range 12-32. Could this be some wierd virus that they came down with at the same time? Could their illnesses be the same disease just different forms, stages etc?
Hello and thank you for the additional questions.
You have made some very interesting points but I really cannot think of any virus which would be causing the symptoms that both of your children have experienced. This may be just some type of coincidence that they had changes in their blood counts during that period of time.
Again this is a very challenging situation. The challenges both for the physicians that are taking care of your children and definitely for you as a very caring the parent. I hope that my discussion and recommendations here are providing you with the information that you really need and the comfort that you deserve.
Sincerely,
Dr. Robert
You have made some very interesting points but I really cannot think of any virus which would be causing the symptoms that both of your children have experienced. This may be just some type of coincidence that they had changes in their blood counts during that period of time.
Again this is a very challenging situation. The challenges both for the physicians that are taking care of your children and definitely for you as a very caring the parent. I hope that my discussion and recommendations here are providing you with the information that you really need and the comfort that you deserve.
Sincerely,
Dr. Robert
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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