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Child has elevated platelet count, granular lymphocytes. Irritable, not eating well, vomiting. Normal?

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concerns about my 3 year old sonmy son is 3. he was premature. he has been having some health issues. his platelet count is chronically elevated at 465 to 495 for the past 7 months. his red blood cell shape is changing slightly. his wbc is overall normal range but granular lymphocytes are elevated 12.8 . he has new symptoms now. he is very Tired all the time. he saya my lets hurt frequently. he has slightly low hgb and hct. his uric acid is 9.9 his co2 is 14. his ast is 68. he is a bit pale. he is very irritable. for about 3 months now he has been not eating well. Maybe 500 to 600 calories a day. his vitamins fluids and electrolytes are fine, he is not iron deficient. and newest development is copious amounts of clear vomit. usually 2 to 4 cups of vomit that is nearly odorless and no food in it. the dr can not find a cause but refuses to send him to a hematologist or an endocrinologist. or any other dr. he also used to have seizures of unknown origin. and he was hydrocephalic when born. in 1st year he had 3 head ct 3x-ray and 9 months gao receive a series of 4 xrays for a broken foot. i am concerns. am i overly worried? is this normal? thank you.
Posted Tue, 9 Apr 2013 in Child Health
Answered by Dr. Gopal Krishna Dash 46 minutes later

Thanks for the query,

I do understand your concern

I have noted your medical problem

Your son has multiple medical issues which require investigations and evaluation in a university medical centre. Please find my opinion as follows

1. Regarding the platelet, hemoglobin, hematocrit etc, I feel that this could be related to anemia. A peripheral smear or if required a bone marrow study under the guidance of a hematologist will resolve this issue.

2. Irritability, vomiting in the background of hydrocephalus needs evaluation in the sense that a raised brain pressure can cause this type of vomiting. Alternate causes of such vomiting could be altered liver functions which should be checked after a neurological evaluation. A repeat CT head will tell us if the hydrocephalus has worsened or not.

3. Seizures; definite cause need identification. This can be done by Elctroencephalogram (a test which maps brain function and tells us if there are seizures). This will help us select a proper medication for him

I sincerely request you to get your son evaluated in a university medical centre having all these facilities.

I hope that I have clarified your query,

Please get back to me if you have any other concern
Above answer was peer-reviewed by
Follow-up: Child has elevated platelet count, granular lymphocytes. Irritable, not eating well, vomiting. Normal? 9 hours later
what neurological concern might cause copious clear voting and irrotability? i also forgot to mention that my son also has separation anxiety and he has trouble self soothing. at the moment i am most concerns with the blood values. i thought anemia would cause low platelets not elevated platelets. additional he is no longer having seizures and he is Tired a lot. he sleeps late into the morning and is difficult to wake and doesnt want to sleep at night but takesra naps . .. he often will fall sleeps. at the table, even when eating. specifically to eating, he is only eating 3-5 bites of each XXXXXXX on average and often refuses snack and drink. he only likes water and drinks a lot of it. he has lost a little weight since XXXXXXX down from 34lbs to just under 32lbs. are these all connected or is it likes that they are.multiple different things going on?
Answered by Dr. Gopal Krishna Dash 8 hours later

Thanks for the feed back

The neurological conditions which can present with vomiting are conditions that increases the pressure inside the brain. In your son's case it could be a worsening of pre-existing hydrocephalus. Please note that anemia sometimes can cause reactive thrombocytosis where the platelet counts can be more. If your son is not having seizures now, you can request your neurologist/epilepsy specialist to review him and get an EEG (Electroencephalogram done). If he is seizure free for more than a year, an attempt may be made to reduce the medications, provided the EEG is normal. If he is on medications for seizures, these drugs can cause lethargy etc. Some medications (topiramate used for seizures), thyroid problem, poor intake etc can cause weight loss. These symptoms could be inter-related rather than multiple separate issues.

As I have advised you for an evaluation in a better centre, may be university hospital, please go ahead with the same. This will help you and you will come to know about his medical conditions and the management also.

I hope that I have clarified you
Please get back to me in case you have any other query in this issue
Best wishes

Above answer was peer-reviewed by
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