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Forum Name: Hematology Topics

Question: Slightly low values on CBC


 mr1313 - Thu Jul 24, 2008 12:40 pm

My 9 year old son had some blood tests in March because he had abdominal pain for 5 weeks with a high fever. The doctor thought he had appendicitis, but it turned out to be a virus. The doctor did a CBC with the following results:

RBC (4.8)
Hgb (11.9) Low
HCT (35.4) Low
MCV (73.6) Low
MCH (24.7) Low
MCHC (33.6)
RDW (13.7)

WBC (7.3)
Neut % (72.7)
Neut Absol (5.4)
Lymph % (15.5) Low
Lymph Absol (1.1)
Monocyte % (11.4) High
Monocyte Absol (0.8)
Eosinophils (0.1)
EOS# (0.0)
Basophil (0.3)
Basos (0.0)

I was diagnosed with alpha thalassemia trait several years ago and told this to the doctor. She did not seem concerned that he may also have the trait and did not want to run any more tests. With the above CBC results, would it be a good idea to take him to a hematologist or is it not necessary until he gets older and wants to start a family?

Thanks for your time.
Melissa
 Dr. Chan Lowe - Fri Aug 29, 2008 11:36 pm

User avatar Hello Melissa,

The anemia is very mild. (A normal hemoglobin would be around 13-14 and your son's is 11.9). The MCV is a little low. This is common in iron deficiency (probably the most common cause of anemia). Normally with iron deficiency the RDW is also elevated.

To complicate things further, following a severe or prolonged illness the bone marrow can be suppressed some causing an anemia (called anemia of chronic inflammation or chronic illness).

In your son's case, I suspect that the later may be a significant cause of the anemia; however, given the low MCV it is possible that he may also be slightly iron deficient. If one wanted to prove this, specific iron studies could be done. Alternatively, he could simply take a multivitamin with iron.

The issue of thalassemia can also cause a low MCV, although with thalassemia I would expect a low RDW and his is on the upper normal side.

So, to try to summarize all this, I would recommend simply rechecking this in 4-8 weeks to see if it has resolved. This will allow time for the bone marrow to recover from the illness. During this time it is also reasonable to have him take a multivitamin with iron to help build up his iron stores. I suspect most of this is the illness.

Best wishes.

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