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Louise Sivak, M.D.
Louise Sivak, M.D., Doctor
Category: Pediatrics
Satisfied Customers: 3499
Experience:  Pediatrician, Board-certified in Ped Hematology/Oncology
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My 5 year old son has had a continual low MPV in his CBC.

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My 5 year old son has had a continual low MPV in his CBC. He has a history of aplastic anemia (diagnosed 10/1/07) but has been in remission, due to IST, with practically normal counts since 10/08. His doctor says it's no big deal but I'm just wondering when is the MPV considered too low? He's also had a raised MCV since his diagnosis which still has not come down to normal. An example of his recent CBC is as follows:

WBC...4.2, RBC...3.96, HGB...12.4, HCT...35.5, retic...0.9, MCV...89.7, MCH...31.2, MCHC...34.8, RDW...12.2, Platelets...217, MPV...5.7, Neutrophils...32, Lymphocytes...53.6, Monos...12.1.

Any information you can provide would be much appreciated. Thanks!
Hello and thanks for your post. In the spirit of honesty, I am a pediatrician and not a pediatric hematologist-oncologist (I don't think there is one on this site). I will give you my thoughts. If you wish that I opt-out to see if a hematologist can give you an opinion I will be happy to do so.

With regards XXXXX XXXXX question, I have seen several references for MPV in children and many say that normal is as low as 6. So by itself, I would not worry about a level of 5.7. The WBC and hemoglobin are OK. However, I do think that your son needs to continue to have serial CBCs done to make sure that everything continues to look OK. It's interesting that this MCV is on the high side but his MPV (effectively the same thing for platelets as the MCV is for red blood cells) is low. Not quite sure why that would be. I would continue to check with his hematologist.

I hope this is helpful. This is a little bit of an advanced question and my response should in no way replace the opinion of a hematologist. However, I would try not to worry about his labs as they currently stand.

I hope this is helpful. Please let me know if I can help in any other way. Best wishes and I hope your son does well. Thank you, XXXXX XXXXX
Customer: replied 7 years ago.

Dear Dr. David,

 

Thank-you for your response. Just a little more information for you: we do visit the doctor for serial cbc's. Also, the main concern I had with these 2 numbers standing as they are is the fact that almost every reason they would be this way is either because it's turning into leukemia or some other worse reason that I'm pretty sure my son doesn't have, like liver failure. His hematologist still seems to think that his MCV is high due to lack of B12/folic acid...which is impossible because he takes like 4x the normal dose of those (under doctor's supervision of course.) His MCV is actually the lowest it's been in over a year & his history with low MPV always correlated before with the need for a transfusion, which he obviously does not need now in platelets.

 

I'm just wondering if he's a ticking time bomb and the doctor just doesn't want to point these issues out to me because he's doing so well. SO, just to quench my thirst for knowledge, IF there is a hematologist who can give me a more in depth answer, I'd prefer if you opt-out. I'm a very medically minded woman due to being brought up by a doctor-father, so I need complete answers. Not that I'm worried, as I know relapse could always occur, and I'm ready for it when it does, but I just like to know the "whys." Thank-you so much for your time & your concern. God bless.

 

-Heather

Sure thing. I am opting out. Dr David
Customer: replied 7 years ago.

Dr. David,

 

Is there a way to either close this question without hurting your 100% feedback or will I be getting a different doctor's opinion soon? Thanks for your help.

-Heather :o)

Hello Heather,
I am a pediatric hematologist-oncologist.
First of all, I am glad your son is doing so well!
We do not get concerned about the MPV (Mean / Average Platelet Volume) unless we are concerned about a child with low platelet count or apparent platelet-related bleeding disorder ; in these cases the MPV and appearance of the platelets can help us differentiate among possible diagnoses. As you may have been told, platelets tend to be the last cell type to recover / come up in a transplanted bone marrow. I suspect that as your son's platelet count inches up higher in the normal range, his MPV may increase as well, but I am not medically concerned.
The MCV (mean cell volume) is higher in a recovering or recently (months > years) engrafted marrow. In a child with IST for aplastic anemia, we would become concerned with a sustained (months) increase in the MCV in case it might say that something is going on in the marrow similar to whatever caused the aplastic anemia in the first place. I don't do bone marrow tests on the basis of increasing MCV alone, but I look a lot harder for other issues. Your son's MCV is not very elevated.
I hope this helps to answer your questions.
I wish your son continued good health.
Louise Sivak, M.D.
Customer: replied 7 years ago.

Hi Dr. Louise,

 

So, what if the MCV has been high since 10-1-07 and this is the lowest it's been? The other hematologist who worked with my son's doctor suspected Fanconi's anemia because his MCV was so high & never lowered (I believe it was always over 100 before this past couple months). Now that we know it is aplastic anemia, how long should I accept an elevated MCV before requesting another bone marrow biopsy? I know his doctor is frustrated with this number because she keeps trying to put her finger on why it's still high...which is why we've continued upping the dose of his B12/folic acid, but it hasn't really changed much. What other issues do you look for with an elevated MCV?

 

Thank-you for your insight!

-Heather :o)

I can certainly understand your frustration.
It's hard for me to make very helpful comments without seeing some of your son's medical records. Do you know what his bone marrow "markers" were in his diagnostic bone marrow test? Has Fanconi's been completely ruled out? Is your son on bactrim/Septra?
If it's trending down, I wouldn't look too hard right now. In an increase situation, I check LDH, uric acid in blood and have several other people review peripheral smear inlc me.
Customer: replied 7 years ago.

Hello Dr. Louise,

Yes, Fanconi's has absolutely been ruled out as his breakage test was completely normal & no abnormal body parts could be found. Josef is not on any drugs at this time, only herbs & vitamins, all of which have been approved by his hematologist as not interrupting anything she's done. The last time he was on septra was I believe in January '09.

 

His most recent bone marrow test showed: 80% cellularity, blasts are not increased, lymphoid gate, 13%, kappa/CD19, 7%, lambda/CD19, 5%, CD5/CD19, 4%, CD20, 13%, CD10, 15%, CD19, 27%, CD5, 49%, CD19/CD10, 16%, TdT, 4% (scattered positive cells). Flow cytometric analysis shows a small population of CD19/CD10 positive cells present.

 

His doc had mentioned a while back that his marrow showed more of a possibility to morph into a different disease like leukemia based on some of the percentages she saw. Does this ring true to you? Thanks again.

 

-Heather :o)

It does, Heather, but with these flow numbers, a trend will be more worrisome if it's in the wrong direction as the above is not worrisome. The better our techniques are to look for things, the more things we find that we cannot always explain.
Hopefully your son's MCV will continue to decrease or stay where it is.
Best of luck to both of you.
Louise Sivak, M.D.
Louise Sivak, M.D., Doctor
Category: Pediatrics
Satisfied Customers: 3499
Experience: Pediatrician, Board-certified in Ped Hematology/Oncology
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