Brief Answer:
All within normal limits. There's nothing to be concerned about

Detailed Answer:
Hi there,

All of your blood work looks very good. Continue your current medications.

Do you have a specific question about your blood work?

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Brief Answer:
See answer

Detailed Answer:
Hi there,

Good question!

Neutropenia is often categorized as mild, moderate or severe, based upon the level of absolute neutrophil count. Mild neutropenia corresponds to an absolute neutrophil count between 1000 and 1500/microL, moderate between 500 and 1000/microL, and severe with less than 500/microL. The risk of infection begins to increase at an absolute neutrophil count below 1000/microL. However, the risk is also dependent upon the adequacy of the marrow reserve pool of granulocytes.

Only about 3 percent of the body's neutrophils are circulating in the peripheral blood. The vast majority of neutrophils are in the bone marrow reserve pool and the remainder is in the tissue and marginated pool attached to the lining of blood vessels. Thus, a standard complete blood count (CBC) done on peripheral blood is, in effect, sampling the very smallest compartment of neutrophils and does not accurately reflect the body's capacity to protect against bacterial infection. The most important issue is whether adequate neutrophils get to the site of infection, not how many are sampled en route from the marrow to the tissue. There is no good clinical laboratory test available to quantitate tissue neutrophil delivery.

Most importantly, if the bone marrow reserve pool is completely adequate, there is no relationship between the degree of neutropenia and propensity to infection. If the marrow reserve pool is normal, patients with an absolute neutrophil count of zero may be at no increased risk of serious infection because of the neutropenia. Essentially, patients with normal marrow reserve are able to deliver neutrophils to the site of infection, and those with no marrow reserve are not.

Since most physicians' exposure to neutropenia is through experience with malignancy or severe marrow failure syndromes, it is important to point out that, for most commonly encountered cases of neutropenia, the patient's propensity to infection may have little relation to the degree of neutropenia.

However, most physicians are aware of the extreme danger present in patients with significant fever and very low absolute neutrophil counts based upon their experiences during training with patients who have received chemotherapy or who have bone marrow failure syndromes.

Ultimately, what we are seeing with your son's blood work is that he has a low neutrophil count due to the carbamazepine - or what is called drug induced neutropenia. It is a common side effect of carbamazepine which is why the medication requires frequent monitoring. However, this is a small snapshot into the big picture of things. The carbamazepine is not lowering the total bodies neutrophil count, but instead it is lowering the amount that we are seeing in circulation. In addition, hydrocortisone may also be decreasing the amount of neutrophils in circulation, but this is still highly debated.

I hope this helps!

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