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Dr. Andrew Rynne

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Suggest treatment for severe muscle pain and fatigue

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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3659 Questions

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Posted on Wed, 8 Mar 2017 in Child Health
Question: Hello, My 15 year old daughter has had some unusual bloodwork (she is being evaluated by an immunologist). I am wondering if you have any thoughts about the following. As background, she has been frequently ill since starting school age 6, mostly throat infections. Then in 2014 had a virus and since then has had muscle pain, bone pain, joint pain, general fatigue like a "chronic fatigue" illness. She was negative for Epstein-Barr but was positive for adenovirus, low Vitamin D, low ferritin. She has Ehlers-Danlos. A few months ago she had her gall bladder removed and afterwards had a routine CBC where her white blood cells were flagged as critically low. Here are some of the recent findings:
- "critically" low WBC (lowest 2.86 up to 3.6)
- low red blood cells (both types) - hematocrit and hemaglobin (not in front of me so I hope that is the right wording - low not critically low)
- normal platelets, but recent test showed low MPV
- low CD-19, high CD-3
- Recent bloodwork had the following: high un/crea ration, low chloride, high anion gap, low alkaline, phosphatase, highish glucose, high albumin
(she has had extensive bloodwork, nothing else of significance was flagged)

The immunologist prescribed a prophylactic antibiotic (Bactrum) and anti-viral but felt she didn't need infusions. Another doctor had recommended an oncology consult - the immunologist didn't feel it was warranted but agreed to make the referral.
She has Ehlers-Danlos, but lupus, etc. has been ruled out. I am partly wondering about the high anion gap, etc. What do those results signify and do they tie into the low white/red cells? Could it be her spleen, something like that?
thank you!
doctor
Answered by Dr. Diptanshu Das 9 hours later
Brief Answer:
Explanation provided.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone through your query. Although your daughter has low WBC count, the number of CD-3 or T-cells is not low (rather its relatively high). This reduces the possibility of an important cause of immunodeficiency. The low CD-19 or B-cells would reduce the humoral or antibody mediated immunity and would make her vulnerable to viral infections. But that does not mean that prophylactic antibiotics would help. Antivirals are usually unnecessary. A high anion gap indicates a metabolic derangement. This brings in the possibilities of organic acidurias or aminoacidurias which need to be ruled out. I say this because she is a known case of Ehler Danlos. However, the problem could also be associated with the high blood sugar value which in turn is possibly indicating a stressful situation inside the body.

I do not think that he spleen is involved. Ehler Danlos is a disease that occurs when the structure of collagen, a structural component of our body, is defective. Many things can go wrong along. It is hard to describe the exact dynamics. I feel the findings to be somehow related. However, I cannot provide you a thorough explanation for each of the findings.

I do not find the oncological referral necessary.

Feel free to write back.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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