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  • Sons Consistant Abnormal Lab Results

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    Old 06-14-2011, 01:31 PM   #1
    dixielandelight
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    Sons Consistant Abnormal Lab Results

    I've been referred by our PCP to a Pediatric Hematologist, I've bascially been told they don't know what is going on cause this isn't their specialty. The Dr I work for, who also isn't a Hematologist said my son's labs were puzzling, but I should be careful as the Hematologist may try to blow it off as Iron Def.

    He's 5, for the past 5 years I've been told he has Iron Def anemia, given iron supp and that's it.

    At 1 his hgb was 9.6. That was all that was checked.

    At 23 months (almost 2) his CBC looked like this:
    RBC 3.8 L
    HGB 9.6 L
    HCT 29.1 L
    RDW 22.5 H

    Earlier that same month his hgb was checked and was 10.6.

    At 3 his CBC looked like this:
    RBC 3.56 L
    HGB 9.8 L
    HCT 28.5 L
    RDW 20.3 H

    He also had some morphology. Polychrom 1+, Hypochrom 1+, Poik 1+, Aniso 2+, Micro 1+ and Ovalocytes 1+.

    At his 5 year check up his CBC looked like this:
    RBC 3.47 L
    HGB 9.7 L
    HCT 28.2 L
    RDW 23.9 H

    He also had some morphology. Polychrom 3+, Acanthocytes 2+, Poik 2+, Aniso 2+, Spherocytes 3+.

    I requested some additional testing. I was tired of being told Iron Def anemia over and over and over. Here's the results, after two full days of being on a large dose of iron, his blood work improved in some ways, but low haptoglobin, and normal iron???.

    RBC 3.57 L
    HGB 10.3 L
    HCT 29.1 L
    RDW 23.6 H

    Iron, Total 59 (27-164)
    Iron Binding Cap 309 (271-448)
    & Sat 19 (8-48)

    This is the first time his iron total has ever actually been checked.

    Haptoglobin <6 L (43-212)



    I requested his birth blood work. He was at a low HCT and high RDW a couple days after birth. He also had morphality then, aniso 1+, poly 2+, poik 1+, crenated rbcs 1+ with slight toxic gran.

    So, anyone have any idea what might be going on with him? Can the hematologist blow this off as Iron Def since the Iron helps the HGB even when his Iron levels are normal and his haptoglobin is so low?

    Last edited by dixielandelight; 06-14-2011 at 01:33 PM.

     
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    Old 06-14-2011, 09:32 PM   #2
    hmm82
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    Re: Sons Consistant Abnormal Lab Results

    Quote:
    Originally Posted by dixielandelight View Post

    So, anyone have any idea what might be going on with him? Can the hematologist blow this off as Iron Def since the Iron helps the HGB even when his Iron levels are normal and his haptoglobin is so low?


    serum iron levels could be affected by the iron supplement so it is possible that he does have low iron otherwise.

    not entirely sure though, because binding capacity is not that high. too bad other measurements of iron status were not checked.

    but, if it is an iron deficiency, then the question is, why low iron? there is a cause for that... either blood loss or absorption issues. that cause should be found and fixed if possible. are they trying to do this?

    if he has been getting iron supplements for 5 years (?!) and still no good, then even more reason to try and find the cause.

    I'm not an expert at all but haptoglobin level would be low in some kinds of hemolysis (specifically, breakdown of the red blood cells inside the blood vessels where it shouldn't be happening)...

    did the doctors explain the meaning of the morphology results to you? (I don't know if those numbers for abnormal cells are too high or not)

    Last edited by hmm82; 06-14-2011 at 09:36 PM.

     
    Old 06-15-2011, 04:16 AM   #3
    dixielandelight
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    Re: Sons Consistant Abnormal Lab Results

    I didn't get any explanation on the morphality. And also, when those iron totals were taken he'd only been on iron for two days, in which I don't see how it could have brought it up if he did have low iron, but I have nothing to compare it too. He was on iron at 1 and 2 I think, but then I switched doctors. His HGB didn't get checked again until a hospital visit at 3 and the anemia wasn't even mentioned to me, I discovered that when I recently requested his records.

     
    Old 06-15-2011, 04:23 AM   #4
    dixielandelight
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    Re: Sons Consistant Abnormal Lab Results

    I also forgot to mention his bilirubin was slightly high at his 5 yr check up. He also had jaundice for several weeks at birth.

     
    Old 06-15-2011, 07:07 PM   #5
    hmm82
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    Re: Sons Consistant Abnormal Lab Results

    Quote:
    Originally Posted by dixielandelight View Post
    I didn't get any explanation on the morphality. And also, when those iron totals were taken he'd only been on iron for two days, in which I don't see how it could have brought it up if he did have low iron, but I have nothing to compare it too. He was on iron at 1 and 2 I think, but then I switched doctors. His HGB didn't get checked again until a hospital visit at 3 and the anemia wasn't even mentioned to me, I discovered that when I recently requested his records.

    well, if they test for ferritin levels, that would show if he has been lacking in iron. ferritin levels would not change quickly from the supplementing (assuming no inflammation), so it would show pretty well what his iron status was like before he started on the supplements..


    I hope the hematologist will take your son's case seriously and help find the underlying cause for this anemia. really all that stuff sounds like it could be more than just iron deficiency anemia though it could be complicated with iron deficiency in addition. I mean, just because there is iron deficiency it does not mean there aren't other things going on causing anemia.

     
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