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Mom of three, MD
Mom of three, MD, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 167
Experience:  Private practice pediatrician; reputation for being a superb diagnostician and caring, loving doc
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High WBC Neutrophils, Monocytes, Eosinophils.Normal

Customer Question

High WBC Neutrophils, Monocytes, Eosinophils.Normal Lymphocytes. High ESR and CRP. Systems Weight Loss, Headaches Fever.My son is 10 years old. He is always tired. doctor has given antibioctics and said repeat testing in 3 weeks. Long wait since she is concerned about leukemia. Antibiotics dont seem to have made much of a difference to him.
Submitted: 8 years ago.
Category: Pediatrics
Expert:  Mom of three, MD replied 8 years ago.
What are his hematocrit and platelet count? Any mention of "atypical lymphocytes"?
Customer: replied 8 years ago.

lymphocytes levels were in normal range from what I read on the test. His platelet count was normal too. He has since finished antibiotics although still complaining of tiredness and headaches and had bleeding gums last night.

Expert:  Mom of three, MD replied 8 years ago.
Especially if something as serious as leukemia is a consideration, it is very important to know the numbers for all three cell lines (that is white cells, red cells, and platelets). Red cell numbers are expressed in "hemoglobin" and "hematocrit". It is reasonable to ask the doctor for exact numbers, not just "normal".

The white blood cell differential gives the percentage of white blood cells that are neutrophils (sometimes called PMN's or polys), lymphocytes, monocytes, eosinophils and basophils. In a viral infection with Epstein-Barr virus, for example, the lymphocyte count is increased, and when a pathologist looks at the sample under the microscope, he/she sees a particular TYPE of lymphocytes called atypical lymphocytes. If, as another example, a child has acute lymphoblastic leukemia, the pathologist sees "BLASTS" under the microscope.

Depending on whether your child's liver and/or spleen were enlarged on exam, and how high the ESR and C-reactive protein were, I think you should not have to wait, but insist on a repeat count, WITH "PATH" REVIEW, as soon as possible. This has to be ordered specifically and cannot be done by a quick automated count; it requires a specially-trained pathologist to look under the microscope.

One would expect that if a child had leukemia, the platelet count would be very low, the hematocrit would be very low, and the white blood cell count would be either very low or very high.

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