My friends daughter has always been really prone to getting sick it seems. She has been bruising very easily and has a loss of apetite and is very sleepy. She had a CBC done and it came back that the Lymphocytes were high and the Neutrophils were low. I don't know the exact numbers, but was wondering what could be causing this. Her doctor had mentioned Leukemia being one of the many possible causes.
Hello and thank you for your question. Could you explain what you mean by 'sick'? How old is she? Do you happen to know whether anyone in her family has a bleeding problem? There are a number of causes for frequent illnesses, but when you add in easy bruising, the scenario becomes a little more concerning. A CBC is a good place to start and I would be reassured if it were normal, making leukemia less likely. The high lymphocytes and low neutrophils could simply represent a viral illness, provided the rest of the CBC is normal.
That said, there are a number of other issues that could be looked into. It may be necessary for her to see an immunologist who would be able to better assess her immuse system and make sure that it's working properly. Abnormal immune systems can cause someone to have frequent infections, but if she is brusing easily then her blood should be checked to make sure she is able to form clots properly. Again, the CBC is one of the tests to check, but there are a couple others, specifially a PT and PTT and von Willibrand's Factor could be added. Her pediatrician can run some basic tests, but if they are abnormal she will need to see a hematologist.
Please let me know if this answer helps, or if you have further questions.
Pediatric hospitalist at a dedicated children's hospital
She just turned 2 on July 10th, and as far as I know, no one in her family has a bleeding problem. Since she was born, she has bounced in between colds, ear infections, pneumonia, and the flu. She just had surgery 2 months ago to put tubes in her ears to help with the ear infections. But it seems like as soon as she recovers from being sick, 2 weeks later she is sick again. We are at a military base so it is sometimes really difficult to get referred to a specialist. When I talked to my friend, she couldn't remember the exact number of everything from the test, just that the lymphocytes were really high and neutrophils were really low, but everything else was pretty much normal.
It can often be difficult to identify a child with an immunodeficiency because the average child can get 6-12 upper respiratory infections (cough and cold) just in the first year of life! That means an average 'normal' child gets a little sick, then gets better, then gets sick again a week or two later. Being around other children, especially in a daycare setting can often make the cycle seem endless.
That said, frequent pneumonias or more serious illnesses warrent further investigation. Certainly people with frequent ear infections requiring tubes are not uncommon, but if the tubes don't seem to help, it wouldn't be unreasonable to start looking at her immune function or even allergy exposure. Also, if she's bruising more easily, her blood should be tested. These things can all still be normal, but they should be looked into.
Thank you for your help.
I do realize you are communicating with another pediatrician about your friend's daughter. I am a pediatric hematologist / oncologist and am very concerned that your friend's daughter may in fact have leukemia or another bone-marrow related process and not just another cold.
I strongly recommend that her pediatrician consult a hematologist to review the slide from her CBC. High lymphocytes and low neutrophils (depending some on abs numbers) are a RED FLAG for further evaluation. Do you know what the numbers were?
Please continue your communication with Dr Mike but please also keep this caution in mind.
Best to you and your friend's child.
Louise Sivak, M.D.
Pediatrician, Board-certified in Ped Hematology/Oncology
Yes I do. Here are the results that she sent to me:
RBC CNT : 4.43
URIC ACID: 2.9
TSH SENSITIVE: 3.37
These are all labs from yesterday afternoon. They also did a TB test and chest xray on her, but I don't know what the results from those tests were.
Thank you Dr. Sivak, I would defer to the hematologist in this case, though the CBC looks normal to me. I question why her LDH is high, however.