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DocPhilMD
DocPhilMD, Medical Doctor
Category: Oncology
Satisfied Customers: 56504
Experience:  Internal Medicine Doctor
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My daughter got pseudomonas bacteria and then was diagnosed

Customer Question

My daughter got pseudomonas bacteria and then was diagnosed with autoimmune neutropenia. She has been on neupogen. During her last bone marrow biopsy, it didn't go well and she didn't stop bleeding a lot for 8 hours so they admitted her. I have Von Willabrands disease, they suspect she has it but has been tested 4 times for the VWF and it has came back fine. We get her CBC and Reticulocyte count done all the time recently her hemoglobin is low. I looked back at her bone marrow biopsy and it showed that her orthochromatic nori last was very high 11.5 when the reference ranges are 0-.88 . I know this is the last blast before it becomes a Reticulocyte. What does this mean, can this be why her hemoglobin is dropping? Also her hemocrit , Mcv, and mch have been dropping and her RDW has been high.my daughter is a year and a half
Submitted: 1 year ago.
Category: Oncology
Expert:  DocPhilMD replied 1 year ago.

What is the primary condition?

She is 1.5 years old?

Expert:  Dr. David replied 1 year ago.

This is Dr. David

if her hemoglobin levels are very low, it is normal to have high reticulocytes and high orthochromatic nori as her bone marrow is trying to make more red blood cells.

this is not why her hemoglobin levels are dropping.

low MCV less than 80 can be a sign of low iron or low ferritin levels which can cause anemia.

if she has autoimmune neutropenia, she could have an autoimmune process also attacking her red blood cells as well.

she should also have her spleen checked to look for enlarged spleen which can be sequestering her red blood cells.

let me know if you have other questions.

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Customer: replied 1 year ago.
Her Reticulocyte are not high the are on the low side which is why I'm confused
Expert:  Dr. David replied 1 year ago.

that is not good

her reticulocytes should be higher as a sign her bone marrow is making more red blood cells.

but her bone marrow may not be able to do this because of low iron or low ferritin levels.

Customer: replied 1 year ago.
We are going to be checking that, but I worry they are missing something because she has a bleeding problem and has constant bruises. How does a kid have all these problems and they are saying they are not related and are separate issues.
Expert:  Dr. David replied 1 year ago.

correct.

I think it is all related in the bone marrow.

the bone marrow makes red, white cells and platelets.

the bone marrow puts the iron into red cells.

platelets are key in clotting.

she might need more bone marrow studies, bone marrow biopsy, flow cytometry studies and cytogenetic studies of the bone marrow to see what is going on in the marrow.

it may be autoimmune disorder attacking all of the cells in the bone marrow.

she might need to go on steroid therapy to help suppress the immune system to help the bone marrow to work properly.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Expert:  Dr. David replied 1 year ago.

do you have other questions?

Expert:  DocPhilMD replied 1 year ago.

Why did she get pseudomonas?

this is a rare condition in a child.

We need to explore that