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
Hi doctor,
My son turned one two months ago. He was last sick two months ago for about a week. He had some standard vaccinations and a routine CBC to check for lead level and anemia. The CBC came back with high WBC and high platelets. His pediatrician was not concerned and said it could be from a recent infection or from the vaccines, etc. To ease my concerns, she offered to retest and we did so. She added markers for inflammation and ferritin level. The WBC has gone down but the platelets are still high. I have attached the CBC results and differentials from three different dates. The ferritin level was 34 (standard 17 to 168 ng/ml) and ESR was 9 mm/hr (standard 0 to 10 mm/hr). So, both were within the normal range. The pediatrician is still not concerned but will send a message to her hematology colleague to verify. I am awaiting the response. Does his report look concerning to you? I am worried it is an early sign of cancer. The lymphocytes are still high despite the overall WBC being within the normal range. Also, eosinophils are high. I see in the differential it shows various abnormal cell shapes such as poikilocytosis, elliptocytes, microcytes, and anisocytosis. What does all this mean? I am trying not to overthink but still am nervous. Besides his abnormal blood test, he has no other symptoms. He is a happy and healthy kid. Please let me know your thoughts. Thank you.
Hello,
Welcome to icliniq.com.
It is good to see that you are aware of your child's health. I have seen the reports (attachment removed to protect patient identity). Let me give you my opinion. Do not directly conclude it as a malignancy, especially leukemia. In the peripheral smear, no blast cells or other abnormal premature cells are mentioned, which is usually seen in acute leukemia. So, the absence of these cells favors an infective or inflammatory etiology. Microcytic indicates a small RBC while poikilocyte means a variation in the shape of RBC. These changes are not suggestive of a malignancy. Your child's absolute lymphocyte count is going down. This suggests a recovery from an inflammation. Lymphocytes are usually high in a newborn or in case of a viral inflammation. So, I do not think you have to jump over to the possibility of a malignancy.
Check your child's liver. If they are enlarged, he needs further work up. If still after a few days, the absolute counts go up, you can investigate further with flow cytometry if needed. You can take the opinion of a hematologist and get your child examined by him or her and you can discuss the information provided to you.
Hope I have addressed your query. Take care.
Patient's Query
Hello doctor,
Thanks for your response. Is it common for reactive thrombocytosis and elevated lymphocytes to occur for this long period of time after an infection or inflammation has occurred? It has been about two months since we initially tested. Thank you.
Hello,
Welcome back to icliniq.com.
Yes, I meant that the blood reports do not show any sign of leukemia.
1. In the peripheral smear report, blast cells, atypical cells, and premature cells are not present. So, I do not think malignancy is a possibility.
2. If the underlying infective or inflammatory etiology is treated, then thrombocytosis will be resolved with time.
3. The lymphocyte count is coming down. So, that suggests he is recovering.
4. But, as you have said, it has been two months. So, I advise you to consult a hematologist in person for liver, spleen and lymph nodes palpation. If any of the organs are enlarged then a malignancy or leukemia should be ruled out.
5. Flow cytometry or bone marrow study can be done if no other cause is found on examination and if it is really needed. But, I still feel that the chance of leukemia is very less here.
I hope your concern is solved. Take care.
Patient's Query
Thank you doctor,
The hematologist responded back. Since the lymphocytes are slightly elevated along with the platelets, she suggested my son have a peripheral smear done. What does this check for and should I be concerned?
Hello,
Welcome back to icliniq.com.
Yes, a peripheral smear examination should be done first in such a case. I thought it was already done as one of the reports had microcytic and poikilocytes mentioned. Anyway, now get your expert peripheral smear examination report and get back.
Patient's Query
Thank you doctor,
I think the reported microcytes, poikilocytes, etc are from the automated blood counter. I believe the peripheral smear is when a pathologist actually looks on a slide under a microscope. Am I correct? If there were no big issues seen on the automated blood counter (for example, no blast cells), is there a good chance that looking under a microscope by a pathologist will yield similar results?
Hello,
Welcome back to icliniq.com.
Yes, the cells mentioned were probably counted using latest methods like automated cell counter. Automated cell counter also can give very good results and if atypical cells were present, it can be detected in a seven-part analyzer. Still, the counter gives a result according to the cell size and granularity, etc. So, a cell counter report should always be correlated manually by looking into a microscope.
So, get your child's peripheral smear examination done from a pathology laboratory and then I can guide you further. The peripheral smear slide can be prepared from a finger-prick sample too.
If any blast cells, atypical cells, or significant premature cells are present, it will be detected. But, the chances are very less.
I hope your concern is solved.
Patient's Query
Hello doctor,
Thank you for your advice. It is very much appreciated.
Hello,
Welcome back to icliniq.com.
You are welcome. Do not worry. Get back whenever you need my help.
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