Brief Answer:
I would advice peripheral smear morphology,hemoglobin analysis,Iron studies

Detailed Answer:
Hi XXXX,
I did review your concern.
From the blood report of your 24 month old baby, it seems likely that your child may have thalassemic hemoglobinopathy. But even if it is there, it is likely to be heterozygous (trait) as the hemoglobin levels are not very low. Thalassemia is a abnormal hemoglobin production machinery where in the rate of formation of hemoglobin is slow. By heterozygous, I meant that the baby may have inherited one gene as thalassemic and other as normal resulting in mild decrease in hemoglobin levels.

The blood report indicates low hemoglobin, low MCV and normal RBC count which is typical seen in thalassemias. RDW is slightly high which is seen in iron deficiency anemia. Also there is monocytosis in peripheral blood.

Did your child have any fever in last few days?
Can you send me the morphological review of his blood slide reviewed by the pathologist?

My advice would be to do a hemoglobin analysis using high performance liquid chromatography (HPLC) or hemoglobin electrophoresis. HPLC is much better test amongst these to detect beta thalassemia. Also if required we can then do iron studies and molecular studies if HPLC comes out normal ( to rule out iron deficiency anemia and alpha thalassemia trait or other rare thalassemic hemoglobins not caught by HPLC).

Also. For the monocytosis, please repeat a blood test again after 3 weeks and if the monocytes do not normalize, a peripheral smear analysis or if needed in rare cases a bone marrow aspiration may be needed. But nothing of that sort now to be worried about, since his platelet count and total white cell counts are normal.Also repeat blood lipid levels after a month to see if they are consistently high and then evaluate accordingly in view of mildly elevated total cholesterol.

As far as future concerns are considered, Even if it turns out a heterozygous thalassemia, you do not need to worry much. These kids do as normal kids do in routine. The two major concerns are-
1) when the child grows up and decides to marry, the spouse can be checked if he or she is not a heterozygous, for the concern of transmitting both abnormal genes to their children.
2) For you as parents, if you are planning another child and the babys result show heterozygous thalassemia, i would recommend both of you parents to be tested for Hemoglobin and blood work up to see your hemoglobin types and evaluate risk of future transmission.

So all in all, The first steps is to
1)Get a hemoglobin analysis in form of HPLC or hemoglobin electrophoresis.
2)Iron studies and molecular analysis for thalassemia later on.
3) please send me the morphological review report.you can upload it here.
4)Repeat blood test after 3 weeks for monocytosis and cholesterol levels to see if they normalize or not and then act accordingly.

Nothing to worry about right now. Many people have such mildly low levels of hemoglobin and they do good.
I hope this helps.
let me know if you have any more questions or concerns. Also provide me feedback of the baby's health and test result.
I wish your family all the best and success..
Sincerely,
Dr Parth Desai

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Brief Answer:
Peripheral smear is suggestive of microcytic anemia.repeat in 3 weeks.

Detailed Answer:
Hi I did review your concern.
The peripheral smear findings are suggestive of microcytic anemia as seen in thalassemia minor(heterozygous) or iron deficiency anemia and few other rare causes. The lymphocytes are atypical mostly because of recent viral infection that causes transformed lymphocytes to be seen in blood.

As I suggested before I would advice you to get a hemoglobin studies first in form of HPLC and then may be iron studies and molecular analysis can be done.

Also please get a morphological review of peripheral blood again after 3 weeks for monocytosis and atypical lymphocytes. they will regress by then as effect of viral infection goes away.
There is nothing worry right now. Its just that incidentally we found out anemia as a workup for fever and that is how these things are picked up on a routine basis.
I hope this helps.
let me know if you have any more questions or concerns. Also provide me feedback of the baby's health and test result.
I wish your family all the best and success..
Sincerely,
Dr Parth Desai

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