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Ask Dr. Yogindra Vasavada Your Own Question
Dr. Yogindra Vasavada
Dr. Yogindra Vasavada, Pediatrician
Category: Pediatrics
Satisfied Customers: 3227
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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My Cousin Daughter had open heart surgery when she was 2...

Customer Question

Hi My Cousin Daughter had open heart surgery when she was 2... Now her age is 4... Recently her hemoglobin reduces to 2 for no reason...

Went to different hospitals and took so many reports and doctors aren't able to figure out the reason.

Submitted: 5 months ago.
Category: Pediatrics
Expert:  Vakularen replied 5 months ago.

I am Dr. Aren and I will help with your query,can you put her reports on the net please?Also is she on any medication?any other symptoms or problem?any history of breathlessness/tarry stools/fever/was a report for occult blood in stool done?Please give me more information ,thanks.

Customer: replied 5 months ago.

Hi Doctor...

Thanks for taking this up..

yes, she is under medication. Is there any way I can attach the images?

Cheers

Customer: replied 5 months ago.

https://we.tl/4ob3wtuvKm

Can you please use this link to download the images?

The doctors say, she produces the required hemoglobin but its not being used and so...

Thank you...

Customer: replied 5 months ago.

No Symptoms... Nerobion, Felvite are the tablets she is taking and Tonoferon syrup...

Our present doctor suggested to put ethrohoyotin wepox 2000 injection once for a week... We've put just one for now..

Expert:  Dr. Yogindra Vasavada replied 5 months ago.

Hi, If she is producing hemoglobin then it should reflect in Hb level at around 12-14 g % in tests.

A level of 2 indicates that either there is no production (reflected by very low reticulocyte percent among red cells) or increased destruction (Hemolysis) by antibodies.

If she has some genetic condition like thalassemia, there would be low production with raised fetal hemoglobin level (FHb). Here giving oral iron like tonoferon is not advisable as may increase iron toxicity. Sometimes, in absence of any genetic cause, anemia may result from inadequate oral iron absorption where giving iron injections may solve the problem.

Please persist

Customer: replied 5 months ago.

the Genetic test also have been done and she doesn't have any problem in it.

Our personal doctor says, that her hb production is normal but the the cells die very fast.

bone marrow test was done and it didn't show any genetic problems.

the main issue is her hb cells die soon after the production

Expert:  Dr. Yogindra Vasavada replied 5 months ago.

The cause of red cell death has to be antibodies to some cell component in absence of gene condition like Sickle-cell disease. Direct Coomb's test would show positive. Giving steroid like prednisolone may help.

Expert:  Dr. Yogindra Vasavada replied 5 months ago.

Which city you are in? If cause is excessive destruction of cells, all iron liberated from this destruction will remain in her systems causing iron overload, so please just give Folic acid + B12 vitamin supplement orally.

Customer: replied 5 months ago.

Thank you so much Doctor...

However, the bone marrow report shows the reduction in iron level. I've asked my cousin to take direct coomb test.

The following link has the image of bone marrow report. Please refer this.

https://wetransfer.com/downloads/ddf6c8c771cd66b2ad7a5291e38e5f3720170209170841/88d9fe

Expert:  Dr. Yogindra Vasavada replied 5 months ago.

This reduced iron level best treated by injectable iron (Imferron) and prednisolone given if coomb's test positive.

Customer: replied 5 months ago.

Thanks Doctor...

They will be doing coomb's test shortly.

will there be chance for any other disease if she has thalassemia?

Thank you

Customer: replied 4 months ago.

Hi Doctor

We consulted with our nearby doctor. They said

there is direct and indirect combs test, to find whether the patient is having any risk in pregnancy with negative blood grouping.

could you please let me know why you suggested coombs test?

Thanks

Expert:  Dr. Yogindra Vasavada replied 4 months ago.
The q fails to download & show up on my device so pl bear some time.
Customer: replied 4 months ago.

Hi Doctor

Any update?

Cheers

Jeeva

Expert:  Dr. Yogindra Vasavada replied 4 months ago.

Coombs test detects any antibodies directed against red cells causing destruction Blood group incompatibility is one instance where mother develops antibodies to incompatible fetus blood of different group.

In older child, some virus or bacteria can cause antibody response which wrongly attacks red cells.

Customer: replied 4 months ago.

Thanks Doctor...

Should we take direct or indirect coombs test?

Expert:  Dr. Yogindra Vasavada replied 4 months ago.

Both may be done.

Customer: replied 4 months ago.

Thanks Doctor... We will do it and let you know.

Expert:  Dr. Yogindra Vasavada replied 4 months ago.

You are welcome.

Customer: replied 3 months ago.

Hi Doctor

We did the Combs test. Both direct and indirect. the results are negative.

Another thing was, last week, she was fine with hb of 8. but for past three days, the hb level went down to 4.

Not sure, why this is happening!

Kindly help

Expert:  Dr. Yogindra Vasavada replied 3 months ago.

Does she have any limb abnormality like bent bones etc? Then it could be genetic condition called Fanconi's anemia.

See : https://ghr.nlm.nih.gov/condition/fanconi-anemia