Is post-surgery WBC dip for germ cell tumors serious?

Question

Hello doctor,

My 15-year-old son recently completed treatment for a primary mediastinal non-seminomatous germ cell tumor. He completed 4x VIP and surgical resection with NED 20 days back. He had one transfusion of red blood cells and platelets two months back after round 4. This month, one-day post-sternotomy surgery his WBC was 7.610 x10^3/microL, hemoglobin 8.7 g/dL, platelet count 131x10^3/microL. He had one to two bags of red blood cells during the surgery. Two weeks post-surgery, his WBC is 2.62x10^3 per microliter of blood, hemoglobin 11.2, and platelet 232. On the same day, he had mild splenomegaly (5 inches). My question is should I be worried about his bone marrow function with the slightly enlarged spleen and dip in WBC? I know this chemo regimen and type of tumor has been linked in rare cases to blood disorders and cancers (I am worried).

Answer 1

Hello,

Welcome to icliniq.com.

Your child is having a rare entity of non-seminomatous germ cell tumor and common extragonadal site for it is mediastinum. Mild splenomegaly is because of malignancy related process and no worry about that and nothing extra treatment needed.

Second, only WBC count is slightly low according to history so it can be because of bone marrow suppression temporarily by malignancy or chemotherapy induced. If clinical improvement present than no need for doing any other investigation. Repeat CBC (complete blood count) after few days and if still, WBC is low then you can consult your oncologist for examination. If any sign of infection occurs like respiratory tract infection (cold), skin infection, etc., then consult the doctor as persistent low WBC count can lead to infection in some cases. Take care.