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Anthony Bray MD
Anthony Bray MD, Family Practice Physician
Category: Pediatrics
Satisfied Customers: 10341
Experience:  14 years Family Practice experience including inpatient and outpatient pediatric care.
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Our daughter is 13 months of age and at her 12 month checkup

Customer Question

Our daughter is 13 months of age and at her 12 month checkup our family doctor orders routine iron tests and CBC.
The test was taken in the days before her 1st birthday and the results indicated a high monocyte count, though all general hematology was all right in the reference range. The absolute values of the first test were (mid March):
(Metric - absolute value X 109/L)
Lymphocytes - 6.2 (4.0 - 10.5)
Monocytes - 0.6 (0.05 - 0.11)
Neutrophils - 2.0 (1.5 - 8.5)
Eosinophils - 0.2 (0.05 - 0.07)
Basophils - 0.1 (0.0 - 0.2)
Following that test the doctor requested a follow up. Our daughter's 12 month vaccinations were coming up (meningitis, etc) and we were instructed to wait two weeks following vaccination before going for a second CBC.
The second CBC yielded the following results (mid April):
Lymphocytes - 7.6 (2.0 - 8.0)
Monocytes - 1.1 (0.0 - 0.8)
Neutrophils - 0.8 (1.5 - 8.5)
Eosinophils - 0.2 (0.02 - 0.65)
Basophils - 0.1 (0.0 - 0.2)
This time around the doctor is less concerned with monocytes and now is concerned with elevated lymphocytes and low neutrophils and wants to escalate to a more senior pediatrician.
I also happened to notice despite the same test at the same lab ~30 days apart a different reference value is noted (as seen above).I inquired with our physician that perhaps it was due to tests before and after 1 year mark, she said she wasn't sure and only goes by what they flag in the result and doesn't know about hematology and to consult the lab. I called the lab and they told me I need to speak to my physician.
I got a second opinion from an urgent care walk-in and they said the results were a little off, but nothing to be overly concerned with and fluctuations at that age are normal. This is in stark contrast to our primary physician's view who seems to be rightfully or wrongfully raising an alarm.
Our daughter is in very good health, only ever had 1 moderate cold, never needed any medication/antibiotics and has never displayed any outward signs of illness or not feeling well. She eats great and is full of energy. At 13 months she's 22.5lbs/85 percentile weight and has gained ~1lb in the last 30 days.
I would like to see another physicians insight on the matter as these conflicting views are both concerning and confusing.
Submitted: 2 years ago.
Category: Pediatrics
Expert:  Anthony Bray MD replied 2 years ago.


The results to me so not seem to be that striking as to slight abnormals of the cell lines.There is no persisting or concerning type pattern here either....for example the lymphocyte cell line if 3 times normal would raise much concern as to some pre-leukemia type process. Nothing of this severity is suggested. The monocyhe count at first does not seem abnomal but rather the given "normal range" seems to be in error...

The slight low neutriphil count on repeat is the only abnormal that to me seems to stand out in the least. This may be a frequent funding if a person is fighting a viral infection. That result could be followed up in 2 months time.

my advise would be to relax...enjoy your healthy daughters..get a follow up CBC to be on safe side in 2 months

I do not see reason for a high degree of alrm here at all!!

I hope that this is helpful for you.Let me know if you have further questions. I will be happy to get back with you. If my answer has been helpful and to your satisfaction then please remember to leave positive feedback.Thank You and Best Regards,

Anthony Bray MD

Customer: replied 2 years ago.
Hello,Thank you for your answer, it certainly has been helpful to put some fears to rest. I did have a few follow up questions:1/ The possible error you see on the monocyte that meaning the reference range is thought to be wrong or the count itself? This struck me as well as in the follow up the reference range. Using the first result and the second/repeat range the monocyte count falls into normal at 0.6 (our pediatrician marked specifically on follow up lab request "monocytes 6x normal" and told us this is the reason for the repeat).2/ Is it possible the vaccination played a role in the low neutriphil count on the second test or likely unrelated?Thank you!
Expert:  Anthony Bray MD replied 2 years ago.

Hello again,

Her monocyte is OK on both first and second tests. The given reference range is too low and in error on first report.

Yes vaccinations may alter white count results as these stimulate an immune response. Lymphocytes and plasma cells produce antibodies so these would be stimulated by a vaccine.(Plasma cells are lymphocytes that alter and migrate into the tissue which is why they are not part of the BLOOD TEST)

The low netrophil count may be in part response to vaccine although this is not exactly an expected result. It is only slightly low and I fully expect it to be normal on repeat.

I hope that this is helpful!! Let me know if I may be of further help! TAKE CARE!!

Anthony Bray MD

Expert:  Anthony Bray MD replied 2 years ago.

Vaccination may indeed affet blood cell counts but we of course do not routinely measure these after routine vaccines... I would tend to expect that neutrophil counts fall when lymphocyte counts rise however..

I hope that this is helpful. Let me know if you have further questions. Best Regards,

Anthony Bray MD

Customer: replied 2 years ago.
Thank you, ***** ***** all of my questions with far more confidence and precision than my daughter's current pediatrician was capable of doing. Besides being very helpful this also confirms my suspicion that I need to get a new pediatrician as in the last year she has never been able to answer any question with the level of detail you just have!Excellent follow up! Thanks again!
Expert:  Anthony Bray MD replied 2 years ago.

You are very welcome! Take Care !!