The Leukemia & Lymphoma Society - Fighting Blood Cancers
21 Replies Last post: Nov 16, 2009 2:47 PM by KellyR   1 2 Previous Next
KellyR   13 posts since
Nov 11, 2009
Currently Being Moderated

Nov 11, 2009 7:05 PM

6 Yr Old Daughter Hospitalized and Severely Neutropenic

Hi, Everybody!  My name is Kelly and I have a 6yr old daughter who is battling some troubling symptoms.  My husband and I are very concerned and am hoping you all might be able to help me understand some of what is going on.  She's are youngest, and we've never experienced anything like this before.  Any input or advice would be great!

Our daughter has been sick on and off for about 9 weeks.  We never really thought much of it.  She has had fevers on and off with no other symptoms, but they were low grade (99.5-101).  She has also missed school at least 6 times for a few days at a time, with what we thought were viruses accompanied by higher fevers (102-103.5).  From Oct 26 to Nov 7, she missed school three separate times, and the 3rd time I immediately took her to the doctor.  In the doctors office she was running a low grade fever(99),  had a rash, a bad cough, and was having trouble walking. Her pediatrician admitted her to the hospital and ordered a chest xray and a myriad of bloodwork.   She came back negative for strep and influenza at first, but later that day, a repeat test came back positive for strep.  She had a positive M Pneumo IGM and her IGG came back slightly high.  She also had a high CPK level of 331 ( normal values per hospital lab 21-215).  She had a urinary track infection and a high PH.  Her CBC was the most troubling.  Her hemoglobin/hematocrit was low, and her white blood cell count was 2100.  Her lymphocytes and monocytes were high, but her neutrophils were low, at 600. By the next morning, after very strong IV antibiotics,  her total WBC had dropped even lower, and her absolute neutrophils were at 300!   We are so frightened.  She has had many symptoms of a much bigger problem for a long time and we didn't put anything together until now. Night sweats, so bad that she needs a bath in the morning, extreme fatigue, the ongoing low grade fevers, and just generally not feeling well.  She has complained of headaches and hasn't had a great appetite for several weeks. She has lost weight, and is very pale.  I feel horrible!  I have 4 other daughters and none of them have been sick.  They are all in school with her, but they all had perfect attendance.  I feel like I should have known something was wrong.  My husband and I both have a strong family history of Leukemia, and both Hodgkins and non-Hodgkins  Lymphoma. Our Pediatrician is concerned and has put her back at home with us but she is basically isolated.  She has to wear a mask and he has said she will be out of school for at least 2 more weeks or until we find out why this has happened. We are to have no visitors for awhile, and she is not allowed to go anywhere except the dr's office.   He is looking at Leukemia, but he says we need to be patient.  We're waiting for the latest CBC differential results.  Am I overreacting? I am a mess.  I'm not sleeping well and I feel like it's taking forever to find out. Am I wrong to think this is not just a simple infection? Our doctor doesn't act like he thinks it is.  I'm assuming the worst, and maybe I'm paranoid, but I don't know how to feel any different.

Does anyone have any ideas, any questions I should ask?    Anybody have any Idea why her Neutrophils would drop so low when her other WCB's were high?  Why would here CPK be elevated?  She's never had heart problems.  And, is being anemic along with the low WBC and neutropenia significant?  I just figured you might be able to give me info in a way I can understand.  I feel like the doctor isn't telling me everything, and then again, I'm not sure what I am looking to hear.  I guess I just need to understand the possibilities better.

Thank You!

JSelf   2 posts since
Nov 12, 2009
Currently Being Moderated
1. Nov 12, 2009 10:15 AM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

I was diagnosed with AML last year.  I had low white cells, platlets, and neutrophils.  I had a month full of sinus infections, weight loss, and eventually bleeding gums.  A bone marrow test quickly confirmed the diagnosis.  If leukemia is suspected, a bone marrow study is the test.  I hope you get answers quick and they are favorable.

 

Jerry Self, Iowa

Shakinquaker   314 posts since
Apr 5, 2009
Currently Being Moderated
3. Nov 12, 2009 1:30 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

I hope you already have answers to questions about leukemia.  By now, I would think they would have ruled it out/in.  I don't really know if there are reasons to be neutropenic without cancer, I am sure that there are, but my experience is strictly with ALL.  My son was almost 4 when he was dx'd.  I really could have written part of your post.  Vague fevers off and on.  that was really his only symptom.  We are fair skinned, so we didn't notice how pale he was.  He had blasts in his blood, so there was no question about the dx by the time there was a blood draw.  He had minimal problems with the Bone Marrow biopsy.  For children, common practice is sedation.  She might be sore after, that seems to vary.  Elias wasn't sore the first time, but the second left him in a great deal of pain.  drop a line and let us know how its going.  Hopefully you'll say goodbye to us and go on your way to a "normal" life.  If it turns out to be Leukemia, this is a great place to be.  Loads of help.

Wobbles   308 posts since
Apr 3, 2009
Currently Being Moderated
4. Nov 12, 2009 2:39 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

Hi, Kelly,

I am sorry to hear about your daughter’s situation, but I am hoping along with you that it will turn out to be a noncancerous issue.


Regarding your daughter’s CBC results, you are definitely correct in saying that she is neutropenic.  Counts of 300 – 600 per microliter are definitely low.  (Mine swing between 200 and 1500 per microliter; I am neutropenic.).  However, I have learned through experience that my numbers bounce around a lot, especially if I have been recently sick.  Even medications can dramatically affect the readings of blood drawn from the peripheral blood system (venous blood).


Also, you mention that your daughter’s WBC was 2100 per microliter when she had a neutrophil level of 600 per microliter.  This means that her lymphocyte count could not possibly be larger than 1500 per microliter.  This is not a high value.  I think you have read the percentage lymphocyte value, which might have indicated it was high.  However, this would be a mathematical artifact in your daughter’s situation. It is best to look just at the absolute densities, not the percentages because it is easy to be misled unless you are used to dealing with percentages.


You mentioned that your daughter is anemic (I am also; my hemoglobin level is 8.5 g per deciliter).  What is her hemoglobin level?

When I saw my hematologist, she said that having two or more blood lines out of whack rings the bell for action to be taken.  In my case this meant gads of blood tests and a bone marrow biopsy.


One question that you can ask daughter’s doctor is, “Are daughter’s symptoms consistent with a purely reactive process?” Reactive processes in the immune system occur when the body is invaded with foreign cells (bacteria, viruses, dirt, etc.).


Keep us informed as to how things turn out.

Joe



Wobbles   308 posts since
Apr 3, 2009
Currently Being Moderated
7. Nov 12, 2009 3:54 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

Yes, this means something.  If daughter is slightly anemic, but has normal number of RBC’s, then either her RBC’s are smaller than normal (look at her MCV number on CBC chart; this stands for mean cellular volume) or her mean cellular hemoglobin concentration (MCHC) is low; it could be combination of both these factors.


Do you know these numbers: MCV and MCHC?


And yes, your daughter's low neutrophil counts are concerning.  As I mentioned in my other post,there are reasons for them to bounce around.  You should expect an explanation as to what is happening.  This could take some time, a month or more.

Joe



Wobbles   308 posts since
Apr 3, 2009
Currently Being Moderated
9. Nov 12, 2009 6:35 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

There are three “flavours” for anemia: micro-, normo-, or macrocytic anemia.  The prefixes refer to the sizes of the RBC’s.  Since your daughter’s MCV is slightly low, her anemia would be classified as microcytic anemia.  (I have macrocytic anemia because my MVC is around 122 femtoliters.)  I take it that daughter’s MCH (mean cellular hemoglobin) is also low.  This would be consequential to normal MCHC and low MCV.

You can google “microcytic anemia” to get a feeling for some of its potential causes.  Like most things in the world of blood disorders, having a specific type of anemia is not diagnostic of anything in particular.  However, it does provide leads for the doctors to follow.

It is important to realize that anemia is a symptom, not a disease.   It needs an explanation.  It is important to rule out iron and B12 deficiencies.  You can ask your doctors if they have ruled these out.  Both of these can be ruled out by a simple blood test.  The RDW is not a good way to rule out iron deficiency.  

Has your daughter had an ultrasound of abdomen?

Yes, daughter’s MCHC is normal.  That’s good, because an abnormal MCHC is a bad sign. Good luck with tomorrow's visit.  If you have questions, write them down.  It is so easy to get to discombobulated in a specialist's office.

Joe



Wobbles   308 posts since
Apr 3, 2009
Currently Being Moderated
11. Nov 12, 2009 7:13 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

I cannot say whether you should ask for one.  I tend to follow advice of my physicians and don’t suggest a test unless I am able to explain why I want the test performed.  I am sure her doctors are trying to take this one step at a time.  The fact they are willing to see her earlier than Monday is a sign of good doctoring.  I know this may be difficult for you, but you need to be patient as the doctors try to determine what is going on.  And I follow your tack of being nice to the doctors.  I've always thought of them as being on my team.  Joe



Elke'smom   208 posts since
Apr 4, 2009
Currently Being Moderated
13. Nov 12, 2009 11:09 PM in response to: KellyR
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

Kelly,

 

Pls excuse me if I have missed this in the posting, but has your daughter been seen by a hematologist yet?  And has there been any discussion of doing a bone marrow biopsy?  Our hospital would sedate her at her age.

 

I don't mean to worry you (but you are already worried), but the description you gave of your daughter sounds a bit like my daughter was before she was diagnosed with A.L.L. last November.  The on-again, off-again low grade fevers (just when you might start getting worried, the fever would go down and you'd dismiss it), tired, not eating properly.  How is she sleeping at night?

 

My daughter also had severe GI issues, though, so she was a bit different, and by the time a blood test was done, there were blasts all over her blood, and her hgb and platelets were so low she needed several transfusions (and WBC was 38,000, I believe).

 

There certainly could be other explanations for her symptoms, but I was told that my daughter had contracted "a virus on top of another virus" by her pediatrician before I insisted on the blood test.  Why don't you initiate a pleasant, inquiring conversation with the dr about whether a bone marrow biopsy is being considered, and why/why not?  They know you're scared and concerned, and should be willing to have this discussion with you.

 

Any other questions, please feel free to post them here.  I hope and pray that it is nothing serious, and you have no need of these boards soon!

 

Ann

 

(PS:  Just had to throw in the discussion that I just got back from Iowa on Monday-visiting in-laws).

Shakinquaker   314 posts since
Apr 5, 2009
Currently Being Moderated
14. Nov 13, 2009 12:03 AM in response to: Elke'smom
Re: 6 Yr Old Daughter Hospitalized and Severely Neutropenic

Hmmm... must be an Iowa thing.  I went to college in Iowa.

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