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- Mon Aug 20, 2007 2:19 am
Hi, my 1 year old son started bleeding from mouth and nose regularly since end of june. Was seen by family physician. Doctor ordered CBC and coag studies. INR and PTT normal.
RBC: 4.93 (slightly elevated)
Diff: (mild left shift and lots of variant lymphs)
neutro: 32% (4.29)
band: 2% (0.26)
lymph: 53% (7.10)
mono: 8% (1.07)
eosino: 3% (0.40)
baso: 1% (0.13)
myelocyte 1% (0.13)
On smear, 1 normoblast seen?
Platelets: 478 (slightly elevated)
History: recurrent ear infection starting at 8 weeks old
tubes put in at 4 months old
2 pneumonias in winter
1 RSV in winter (6 months old)
Now 13 months old with no signs of viral or bacterial infections. Besides the bleeding, seems healthy.
Should I be worried of smear findings even if WBC is normal for age and no signs of infection? What do you suggest?
| Dr. Chan Lowe
- Mon Aug 20, 2007 10:17 pm
Myelocytes and normoblasts are simply immature forms of normal cells in the blood. If the bone marrow is rapidly producing cells (as in the case of a recent infection or inflammatory response, for example) it can sometimes push out a few of these less mature cells.
Small amounts such as your son has are generally not concerning. Larger amounts may be indicative of a problem with maturation causing the cells to stop maturing (such as in lymphoma or leukemia).
I would recommend your son have a repeat CBC in the next few weeks to see if this has resolved.
Regarding the nose bleeds, common causes of nose bleeds in young children include trauma, and dry air/nasal passages. You may want to try using a humidifier at night or using a nasal moisturizer several times a day for a while to see if this helps.
The most common organic cause of nose bleeds when looking for a blood problem will be Von Willebrand's disease that can be tested for by looking at the ristocetin cofactor level.
- Tue Sep 11, 2007 1:08 pm
Thank-you for your information. After original posting, my son started to have blue lips for long period of time. It last for a couple of hours and then comes back to normal. Also, he started to have nightsweats...to the point I have to bath and change him. He went for another CBC. Results are about the same with one difference. WBC count normal but monos and baso are slightly elevated and presence of many variant lymphs. I actually looked at the smear and there is one cell I have never seen in 10 years experience.
It looks like a lymphocyte but the cytoplasm is scant and the nucleus have numerous lobules...looks like popcorn or brain-like. Many of the`'variant lymphocyte' seen have a slit in the middle of the nucleus.
My gut-feeling: lymphoma cell. The thing is that I have not seen any before.
Even worse, the tech who read the slide did not comment on any of this so family doctor has NO clue that something might be wrong.
What do you suggest I do? What are the symptoms of lymphoma and what tests should I ast for confirmation of diagnostic?