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What do elevated neutrophil count and raised CRP level indicate?

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Posted on Mon, 29 Aug 2016
Question: Hello, my daughter (almost 3yrs old) said one day after kindergarden that she had stomach upset. As we came home, she pooed normally and I thought that was it. But then she started to vomit a lot - 2-3 times in 2 hours. She vomitted all she had in the stomach (veggie soup) and got high temperature (38,5C). We tried to keep her hydratated but she vomitted everything (even when we waited for 2-3hrs after giving her only black tea with spoons). As a result, we ended up in a hospital because she had ketones in her urine. She got much better as they gave her IV therapy. They did the blood tests and the liver tests upon her admission to the hospital, and the liver tests showed ok. Then, later, they repeated the blood tests but without testing liver, and these were ok so we went home. Then, 3 days later we went for a check and the blood tests showed that she had elevated liver tests (ALT, where the reference value was <1, she had 2.88, AST around 3.36, with reference around 0.80). They presumed hepatitis, but how come that the first blood test they did to her did not have any elevated liver test? Also she got elevated neutrofiles. Do you have any suggestions of what might be the cause of her elevated liver enzymes? (she had already overcome rotavirus 1 year ago). Also, her CRP was around 8 when they admitted her to the hospital. Thank you. (Also, they didn´t check her poo as she didn´t poo in the hospital, we only brought a sample today for further check). I don´t see any bilirubin values in her blood test results.
doctor
Answered by Dr. Diptanshu Das (2 hours later)
Brief Answer:
Give her plenty of fluids to drink. Give juicy fruits like citrus fruits.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone through your query and understand your concerns. A raised neutrophil count as well as a raised CRP (could you please mention the unit and the mentioned value of permissible levels, it varies) indicates a bacterial infection. It seems that your child has got an intestinal infection which is responsible for the vomiting and passing loose stools. Under such a circumstance I find no reason to suppose that she has a viral hepatitis.

Ketones in urine occur during starvation. In case of young children as yours, continuous vomiting will lead to poor food intake and thereby some sort of starvation. In such a case all you need to do is to arrange to deliver the nutrition in some form.

About the raised liver enzymes, I would need the specific values along with the measuring units in order to be able to answer your question. Nothing needs to be done about it and all you need to do is to let the liver get some rest.

I would await your response.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Diptanshu Das (4 hours later)
Hello,
thank you for your advice. The CRP wa actually very low (0-5 is considered normal and she had 8, which wasn't high at all). Her stool was not liquid or loose. She actually had a stool only once before going to hospital and then nothing for the next 2-3 days. She only vomitted but no diarrhea at all, nothing wrong with her stool.

About the elevated liver results: they did three blood tests -
1.when they did the tests upon her admission to the hospital, it was allegedly ok.
2. Before we went home, they tested the blood but not the AST,ALT and the blood results were normal.
3. But once we came for a check 3 days later, she had the elevated liver results. While the normal AST is 0,05-0,80 μkat/l, my daughter had 2,88 and while the normal ALT: 0,1-0,80 μkat/l, she had 3,36. so it's like 5x above the upper level, which is a lot.

Because of these results, the doctor suggested that my daughter had hepatitis. My question is: Do you think from the information that I gave you that it really is hepatitis? (and could you explain why you think so?). What other things could have caused that my daughter had elevated liver tests? What might be the reason behind it?

Also, the doctor seemed to think that the issue is quite serious as the elevation was so much above the norm. What is your opinion about the AST, ALT being so much above the limit.

Thank you.

ps: I contacted the director of the kindergarden and the director said that everyone else was present (no one else was sick) - so my daughter was the only one sick.

My main concern are the elevated liver results and the possible cause of it.
doctor
Answered by Dr. Diptanshu Das (6 hours later)
Brief Answer:
The range of variation is not same for all the tests.

Detailed Answer:
Thanks for writing back.

Let me correct your understanding. A CRP greater than 5 (here) indicates some sort of infection or inflammation. The value is high enough to give such an indication and that correlates with the gastrointestinal infection in discussion.

The range of variability is not same for all tests. While slight deviation in some may be significant, in others a gross deviation might be needed to consider it to be a significant deviation. For example, while a normal blood amylase level is 23-85 units per liter, (U/L), it may easily go to levels like 2500 U/L in case of pancreatitis. (Well how many times is it?) So, in order to be able to comment on what is 'a lot' in which case requires medical expertise.

We treat patients and not investigation reports. Besides, even if it is viral hepatitis, all you need to do is 'nothing'. Just let the child eat light, bland food and the body will take care of the rest gradually. It is only a matter of time before recovery comes. If you want to worry, you are free to do so but I do not see how it will help the situation.

Be concerned about the overall health of your child and not about the reports. If you have a diagnosis (like viral hepatitis), rather than being concerned about it, get concerned only about the steps to be taken. Nothing else. If that is the case, you need not worry. Things would be back to normal soon.

Children fall ill all the time. It is something that is a part of life. Nothing to be apprehensive about.

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

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Practicing since :2005

Answered : 3828 Questions

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What do elevated neutrophil count and raised CRP level indicate?

Brief Answer: Give her plenty of fluids to drink. Give juicy fruits like citrus fruits. Detailed Answer: Thanks for asking on HealthcareMagic. I have gone through your query and understand your concerns. A raised neutrophil count as well as a raised CRP (could you please mention the unit and the mentioned value of permissible levels, it varies) indicates a bacterial infection. It seems that your child has got an intestinal infection which is responsible for the vomiting and passing loose stools. Under such a circumstance I find no reason to suppose that she has a viral hepatitis. Ketones in urine occur during starvation. In case of young children as yours, continuous vomiting will lead to poor food intake and thereby some sort of starvation. In such a case all you need to do is to arrange to deliver the nutrition in some form. About the raised liver enzymes, I would need the specific values along with the measuring units in order to be able to answer your question. Nothing needs to be done about it and all you need to do is to let the liver get some rest. I would await your response. Regards