Q. Why did my 2-year-old son lose weight and have enlarged lymph nodes in the neck?

Hi doctor,

I have a two-year-old male child. He gets frequent colds and illnesses since infancy. He also took three courses of antibiotics to clear an ear infection. He has dropped from seventh percentile weight to third percentile weight, now gaining back to the eighth percentile. Weight loss and enlarged lymph nodes in the neck began eight months before. He is not interested in food, takes only a bite or two, and is supplemented with multi-vitamin, iron, vitamin D3, and a health drink. Bloodwork reports are, WBC- 2.5 x 109/l, RDW- 15 %, neutrophils- 0.9 x 109/l, lymphocytes- 1.3 x 109/l, moderate echinocytes (burr cells), reactive lymphocytes present, IgG- 10.20 g/L, total IgE- 122 kU/L. We are looking for a second opinion on what next steps we should take or what illnesses we need to explore or rule out. We are waiting for a referral to a hematologist, but waiting time is more here. If important will take him for faster exploration and treatment. Please help.

Hi doctor,

Thanks for your reply.

I uploaded the recent blood work results (attachment removed to protect the patient’s identity). Unfortunately, I do not have additional information at this time. I am not familiar with what artifact in samples means. Does that change the implication of echinocytes? What may cause lymphocytes to be low and reactive lymphocytes present? The pediatrician mentioned considering leukemia with his hematology referral. Could that be a probable differential diagnosis, and is that a reasonable consideration based upon this bloodwork, weight loss, lack of appetite, and chronically enlarged lymph nodes? Please help.