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Why does my son have a low hemoglobin level and low-grade fever?

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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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Published At February 28, 2022
Reviewed AtDecember 20, 2023

Patient's Query

Hi doctor,

My son is 13 years and six months old and has had a low hemoglobin level of 9.8 g/dL for the past year. The doctor suggested a Tasiron iron supplement, but it did not improve. Regular beetroot juice, pomegranate juice, a non-vegetarian diet, and homeopathic Iron sulfate supplements did not help either. His blood CBC report peripheral blood smear test is normal. Electrophoresis tests are normal. Iron studies report shows low ferritin (7.3 ng/mL), low iron serum (24 µg/dL), percentage of saturation (5.7 %). Urine, stool tests, blood culture reports, thyroid tests, and liver function tests are normal. However CRP is high (around 17 mg/dL), ESR (18 mm/hr). One other problem we observe is that his body temperature in the evening often goes up to 99.5 °F with no other major symptoms. He has been gaining height and weight. What is the cause of low hemoglobin, and how to improve this? Kindly help.

Answered by Dr. Arpit Varshney

Hello,

Welcome to icliniq.com.

I can understand your concern. Iron deficiency is not only the cause of low hemoglobin in your son. He has some chronic infection or illness that prevents his hemoglobin from building up. Based on low-grade fever and high C-reactive protein (CRP) levels, I could infer all this. Generally, in India, tuberculosis is more common. But since you did not mention any other symptoms, it would not be easy to diagnose the root cause. The good thing is his growth is not affected. Otherwise, a few chronic infections can lead to growth retardation also. I will need a detailed and thorough history of your child and suggest a few tests to reach the root cause.

I would suggest tablet Livogen XT (Ferrous Ascorbate [Iron], Folic Acid [vitamin B9], and Zinc Sulphate) as your child is above 12 years of age.

I hope this helps.

Kindly revert in case of further queries.

Patient's Query

Hi doctor,

Thank you for the reply.

Here is a detailed history of issues in the last 12 months. Let me know if you are looking for anything specific. Eight months ago, my son had a viral infection when CRP was high (expected), and we did take a blood test at that time and detected low hemoglobin for the first time. He had a viral infection again seven months back but did not do blood tests. The symptoms were similar to dengue. COVID test was negative. Five months ago, we observed a mild increase in body temperature in the evening for three to four days, and we did the blood tests again. We found that CRP was high, platelets were slightly higher than normal with low hemoglobin. We consulted a local doctor but could not find anything unusual.

Four months back, we observed a mild rise in body temperature in the evening for three to four days, and this was recurring every two to three weeks. Since the local doctor could not find anything unusual in physical examination, did urine, stool, blood culture, abdomen sonography, and the results were normal. Three months back, we started some homeopathic medicine for two months, and we did not observe any rise in body temperature. But after that, we again saw an increase in body temperature, so we rechecked blood, the results were normal. We did tests for typhoid, malaria and all were normal.

He also has allergic rhinitis kind of issue, and he sneezes frequently. He has not had diarrhea, constipation, or stomach pain, so it does not seem like a stomach issue. The rise in body temperature has always been in the evening and recovers by night by 11 PM. Sometimes it comes down in a couple of hours without any medicine. Temperature does not rise more than 99.5 °F (underarm). It got raised to 101 °F eight months back. In the morning hours, it has always been around 96 °F. He does not have body pain, joint pain, cough, fatigue, and body rashes. He has scalp dermatitis. He does some mild exercise every day without any issue. His height is around 4.92 feet, and his weight is 99.21 Ibs. He has gained about 3 kg in the last three to four months. His appetite is fine. What further tests we should do to find the root cause. Kindly help.

Answered by Dr. Arpit Varshney

Hello,

Welcome back to icliniq.com.

I understand your concern. The persistent high CRP and fever can be a marker of infection and autoimmune disease. Your son fits into the pyrexia of unknown origin (PUO) description. I will suggest you read a bit more about it on the internet. I also suggest the following test to find out the cause,

1) Chest X-ray posteroanterior view.

2) Mantoux tuberculin skin test (TST).

3) Galactomannan test.

4) Procalcitonin (PCT) test.

5) 1,3-Beta-D-glucan test.

6) Contrast-enhanced computerized tomography (CECT) of chest and abdomen.

7) CBC (complete blood count) with peripheral blood smear (PBS).

8) Reticulocyte count.

9) Bone marrow aspiration and biopsy.

If all of this is normal, PET-CT (positron emission tomography and computed tomography) scan is the last test we do in patients of PUO with all normal reports. Also, I would like to see a urine routine microscopy report. Many times hidden infections in kidneys can be a source of PUO. Do you have pets at your home? Infections from pets can cause PUO, e.g., brucellosis. These tests are entirely worth it as living everyday life is more important than suffering from fever every day. The good thing is your child is mildly symptomatic.

Kindly revert in case of further queries.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Arpit Varshney
Dr. Arpit Varshney

General Medicine

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