Dr. Goswami Parth Rajendragiri
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My boy baby is 16-months-old. I just want to know why my baby gets pale and has anemia and whether his current blood work is better. He has IgE mediated allergies, FPIES, a history of eczema, chronic constipation, history of intermittent fevers (103 degrees Fahrenheit) in the last couple of months. Constipation gets resolved with a glycerin suppository. GI imaging and testing were done, but nothing was found. Currently, he is given Epipen, Zyrtec, and Zofran for food allergies as needed. Blood work, taken before four months, showed anemia. He was hospitalized with neutropenia - ANC 100 and diagnosed with roseola. Blood work shows - rare nucleated RBC, polychromasia, microcytes, macrocytes, and anisocytosis. MCHC 31.5 g/dL - low, platelets 635 x 10^3/uL- high, lymph - 70 % atypical lymphocytes, lymph (absolute) 6.2 10^3/uL - high, NRBC 1 % - high. X-ray chest shows no pneumonia.
Hematological comments: manual differential was performed.
Hello,
Welcome to icliniq.com.
Following is my opinion on your asked question. The boy is having a roseola viral infection in which human herpesvirus 6 (HHV 6) is positive. I have seen the attached report (attachment removed to protect the patient's identity). It is suggestive of a viral infection.
His neutrophil and hemoglobin might be low because of bone marrow suppression. Neutrophils and red blood cells (RBC) are produced from bone marrow. So if bone marrow suppression occurs, the total count can fall down. Microcyte, macrocyte, and polychromatic red blood cell (RBC) suggest anemia with hemolysis.
Symptomatic management is done in roseola like a viral infection. The patient is given antibiotics and fluid and requires symptomatic management.
Lymphocytes were high, especially reactive ones in complete blood count (CBC), which is due to the viral infection itself. In the latest complete blood count (CBC) report, the total count is within range, so do not worry about that. Keep him hydrated with lots of water and follow your doctor's advice.
I hope I have answered your question. Let me know if I can assist you further. Best regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Is it normal for a baby to experience myelosuppression? Why does that happen when he gets sick? Is this connected to his food allergies and eczema? His immune system seems to overreact all the time (severe allergies, hives, etc.); what could be the problem? He also gets intermittent random fevers (103 degrees Fahrenheit) and no other symptoms. All his imaging is fine, but he is always sleepy and anemic.
Hello,
Welcome back to icliniq.com.
Following is my further opinion on your asked question.
Sometimes in a few patients, bone marrow suppression can occur. But it is temporary suppression. Once immunity starts working and the virus is cleared from the body, suppression is reversible, and complete blood count (CBC) starts improving like in your case. However, if he still has a fever, I suggest you talk to a pediatrician about that, and a detailed physical evaluation can be done and, accordingly, further management.
His thyroid level can be checked for further workup as well if your doctor feels that. Allergic inflammation does not lead to bone marrow suppression and low white blood cell (WBC) count.
I hope I have answered your question. Let me know if I can assist you further. Best regards.
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Pathology
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