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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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Hi - my toddler will be 3 in October. Had some blood work done

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Hi - my toddler will be 3 in October. Had some blood work done and some #'s are off. Waiting on a call back from a hematologist. Here are the numbers that are off:

MCHC: 35.2 gm/dl (range 31.0-35.0)
NEUT #: .06 K/UL (1.5-8.5)
NEUT %: 9.3 (26-60)
LYMPH %: 82.2 (35-65)
RBC MORPH- ABNORMAL
PLT: SLIGHT PLATELETS PRESENT

Please help me understand. My mind is racing and I need some help while I wait to see a hematologist.

Thank you!

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

Can you tell me why the blood test was done in the first place?

Dr. A. Clark :

Since you are offline let me see if I can put your mind at ease. First, you have to realize that most physicians don't have their own labs so send blood to labs such as Qwest who report back to the doctor but don't correct the normal result ranges for age since most of the blood their receive is from adults.

Dr. A. Clark :

Second, the ratio of neutrophils to lymphocytes is shift toward the more lymphs which we see in kids all the time with viral infections.

Dr. A. Clark :

I see you are typing so I'll wait for your reply.

Customer:

Hi - we suspected a peanut allergy. The blood work was ordered to check for peanut allergy and other food allergies -all of these came back negative. he then decided to do the other blood work since her 3 yrd old wellness check up is coming up.

Customer:

She hasn't had a cold (or fever) viral or bacterial since Feb 2013. That was her last cold of the "cold season"

Dr. A. Clark :

I see but I don't understand what the CBC was checking for regarding peanut allergy other than perhaps a high eosinophil count.

Dr. A. Clark :

Can you tell me what her total WBC count was?

Customer:

total WBC was 6.6 (k/ul) range 5.5-15.5

Dr. A. Clark :

So her WBC count is NORMAL and thus the shift to lymphocytes is likely related to some recent incident such as allergy or a viral infection.

Dr. A. Clark :

What was the total platelet count? It is usually in the 125,000 and up range.

Dr. A. Clark :

What was her Hemoglobin (Hgb) and hematocrit (Hct)?

Customer:

platelet count? is that PLT?

Customer:

if so it states 235 k/ul (ratio 150-400)

Dr. A. Clark :

Yes

Dr. A. Clark :

And that is normal too. Hgb or Hct?

Customer:

HGB 13.1 g/dl (range 10.1-15.1)

Customer:

HCT 37.2 % (range 33.0-43.5)

Dr. A. Clark :

The numbers are all normal and you can ignore the MCHC and I have no idea what "slight platelets present" means but we see these all the time in kids and ignore them as they are not applicable for her age.

Customer:

does it look like she's anemic?

Dr. A. Clark :

What did her doctor tell you and how did a hematologist get involved?

Dr. A. Clark :

No, her counts are NORMAL!!

Customer:

he sent me to a hematologist - waiting on a call back to review her results.

Customer:

even her .06 Neut?? thats the one that has me really scared!

Customer:

everything i searched comes up Cancer with such low neut

Dr. A. Clark :

I am having a hard time understanding why he sent you to a hematologist with a normal total white count, normal hemoglobin, normal platelets and a viral shift in her white blood count ratio only, which we see all the time.

Dr. A. Clark :

This is not leukemia or anything else serious with just a low neutrophil count that is likely only due to some stimulation of her immune system recently.

Customer:

WOW! ok - you been extremely helpful! I will voice my concerns.

Dr. A. Clark :

Having planted that terror in your head now I suspect you'll want to have the hematologist's blessing too but I am perplexed by all the excitement. May I ask about your pediatrician's experience - younger, recently trained, etc?

Customer:

Not younger at ALL - the practice is great. but i do feel he's a little over cautious so this may be one of those times HOWEVER its extremely scary.

Customer:

i respect his double checking But what happens is I'm left with no answers and thats hard.

Dr. A. Clark :

As I always say, one bad test deserves another and what I would do is just repeat the blood count first to reassure everyone she is fine.

Customer:

We will do just that.

Dr. A. Clark :

White cells always exist in a ratio with neutrophils being the predominant type but in children, especially younger ones, just the trauma of drawing blood throws the ratio off (called demargination). We see this all the time and I have to tell you I not only ignore it but I don't even tell parents about these minor variations as the result is always panic over something that is not worth worrying about in an otherwise healthy child.

Dr. A. Clark :

Again, a simple hemoglobin is all that is indicated with checkups for this very reason since children's white counts vary wildly just due to the trauma of drawing blood. Here is a link to the American Academy of Pediatrics checkup schedule that most pediatricians follow and you'll see that a hemoglobin is what is recommended, not a CBC:

Customer:

Thank you so much! i will read the link you sent me.

Dr. A. Clark :

Sorry to get on a soap box with you about your doctor but this is something I see all the time as a "seasoned" pediatrician with 34 years of experience. More and more kids get referred for specialty evaluation when just thinking through it a bit is all that is indicated.

Customer:

I understand and its a good point. I will voice my concerns.

Dr. A. Clark :

As I tell the newly trained docs who join us, you have to understand the difference between knowledge and wisdom. A good example to illustrate this is knowing that a tomato is a fruit but wisdom tells me not to put a tomato in a fruit salad!

Customer:

Understood! thank you again.

Dr. A. Clark :

Have a great day and don't worry!

Dr. A. Clark :
Please remember as you exit chat to rate my service as that is the only way experts are compensated for their time! If you feel unsatisfied with my answer at all please don't exit but just hit the REPLY tab and let me know of the issue or question that you have. I will be happy to continue working with you and will do everything I can to provide you with the service you seek and I hope that I can earn an excellent rating from you.

Dr. A. Clark :

Did you have any further questions? Chat will time us out and kick us off after 4 minutes if neither of us posts a comment. I'll stand by just in case.

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