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High LDH, AST, ALT normal. Blood test done. Taking Depakote. Suggestions?

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Practicing since : 2008
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Diagnostic ideas for 15 year old with epilepsy, progressive fatigue and increasing "hot sweats"?
15 yo male. CBC has consistent levels which remain out of range over numerous samples during an 18 month period. Slight trending in wrong direction. Current view.

Range 9/18/13
Absolute Neutrophil 2.73–6.68 1.69
Absolute Lymphocyte 1.03–2.18 2.08
Absolute Eosinophil 0.04–0.2 0.27
Neutrophil/Band 43–77 37
Left Shift Present (new!)
Lymphocyte 8–41 46
Monocyte 4–8 8
Eosinophil 2–4 6
Basophil 0–1 0
Atypical Lymphocyte 0–4 3

CBC Range 9/18/13
WBC 5.24–9.74 4.54
Hemoglobin 11–14.3 14.1
Hematocrit 31.4–41 42
Platelet 168–339 158
MPV 7.5–8.3 9.5
RBC 3.74–4.93 4.72
MCV 80.8–86.6 89
MCH 28.2–30.5 29.9
MCHC 34.2–35.6 33.6
RDW 13–14.6 13.3
HDW 2.65–3.15 2.57

Taking Depakote (750mg daily; levels within range at 68)

7 hours ago
- 4 days left to answer.

Additional Details
I am asking this question to solicit some thoughts which I can use to ask better questions of his medical team who continue to be puzzled by his presentation - including physical symptoms, abnormal indicators across a spectrum of tests .. but none which have been differentiated enough to lead them in one direction vs another. They are asking for my input since I told them he was having seizures 3 years before it could be seen on the EEG (when he started having more acute clonic tonic and partial seizures) and I was reporting increasing fatigue before it came severely debilitating.

1 hour ago
The blood work recently included LDH (Lactate Dehydrogenase) which was high at 243 (vs range of 100 - 210). AST/ALT both normal. He has not presenting with any fevers and infection disease panels are all negative, Erythrocyte Sedimentation Rate is normal at 2 (vs range of 0-20, though down from 7 from a year ago).

I am really just trying to educate myself so I can work with his medical team. I am in Boston, great doctors and hospitals but this has been a long journey without many clear answers .. though some new results which I hope can help differentiate a diagnosis.
Posted Fri, 11 Oct 2013 in Men's Health
Answered by Dr. Shruti Rijhwani 6 hours later
Brief Answer:
Needs further evaluation.

Detailed Answer:
Dear sir ,

Thank you for posting your query on XXXXXXX

Well looking into your problem I would like to tell you that reading the reports and whatever history you provide is very non specific . Only thing we can go by is our instincts .

Still in my opinion few things need to be ruled out . One is SLE in which you can have varied presentations and may be other CTDs . Second hematological malignancies like lymphoma . Third would be tuberculosis .

I would advise you to get XXXXXXX , ENA profile , Reticulocyte count ,PET scan , Mantoux test , Gold quantifern TB test . If all these dont reveal anything Bone marrow examination should be done.

Take care.

Hope this helps you .

Dr. Shruti
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