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Forum Name: Pediatric Topics

Question: is my boy has thalessemia?! low MCV &MCH in blood test!


 om_3abadi - Sun Jan 04, 2009 8:23 am

Hello;

my 14 months old son has toothing problems since he was 9 months after i cut the breastfed. has fever most of the month and diarrhea and no appetite, first blood test was before 2 months
Hb =9.5 gm/dl
PCV% = 29.0

i gave him vitacor drops, which is multi vitamin, iron and mineral drops
20 drops daily divided twice


next month the blood test was
Hb= 10.7
PCV= 32
still on the vitamin and his appetite get better thank God

today i make for him a CBC test and i eas fully terrified would he has thalessemia or not, cause the nurse face make me feel so!!

results was
Hb =11.5 normal (9.5-14.5 mg/dl)
Hct (PCV)= 34.40 normal (29.0-44.0%)
RBC= 5.57 normal (3.9-5.2mil)
MCV= 61.76 normal (74-84 fl)
MCH= 20.65 normal (24-28 pg/cell)
MCHC= 33.43 normal (31.0-35.0%)
WBC= 15.10 normal 6-18 (1000)/c.m
Platelets Count= 140 normal (140-440 (1000)/L
--------
Neutrophils: 14%
Eosinophil: 4%
Basophil: 0%
Lymphocyte: 78%
Monocyte: 4%

notes:
-he has fever today due toothing
and i gave him drug discount temperature

-his father has no thalessemia, i don't know if i have! but my Hb always good between 12 -13


appreciate your advice
 Dr. Chan Lowe - Sun Jan 04, 2009 11:04 pm

User avatar Hello Om_3abadi,

MCV and MCH are both marker of cell size. The can be low in thalassemia; however, there are many more reasons they can be low as well. There was one value on the CBC that I did not see in your post. Do you know what the RDW value was?

One of the most common causes of low MCV and anemia is iron deficiency. With significant iron deficiency, daily multivitamins with iron are unlikely to have enough iron to overcome and correct the deficiency in a timely manner. Typically, the recommendation is "treatment" doses of iron for 2-3 months then returning to a "maintenance" dose. With iron deficiency, along with the anemia, there clasically is a low MCV and a high RDW.

With thalasemmia, the MCV is low but the RDW is also low. RDW is a measure of the variation in size of the red blood cells. In thalassemia the red cells are small but basically all the same so the RDW is low. (With iron deficiency, new red cells being made are large while old ones are smaller causing the RDW to be high.)

Another common cause of anemia is chronic illness or inflammation, although this often does not depress the MCV quite as much (but can do so). I would suggest talking with your son's doctor about the CBC results and seeing if further testing is needed. If needed, iron storage levels can actually be measured to see if they are low.

Best wishes.
 om_3abadi - Mon Jan 05, 2009 2:18 am

so thankful for you doctor
& God bless you
 Dr. Chan Lowe - Tue Jan 06, 2009 8:22 pm

User avatar My pleasure.
 om_3abadi - Sun Jun 14, 2009 9:58 am

hi,

i am writing again in the same topic, and hope doctors advice me for the next step of my son

he is now 20 months years old

me made for him another tests due his doctor's advice
the doctor ask me to stop the multivitamines and give him
(Maltofer) syrup (an oral iron therapy)each i ml contains 10 mg iron as Iron(III)-hydroxide polymaltose complex

his dosage according to the weigth= 6 ml daily for a month
milk before or after an hour not less than that, to give good iron absorbing

then the analysis was done for him

this is the results:
----------------------

hematology test
--------------------
hemoglobin: 11.9g/dl (11.5-14.5)
RBC: 4.69*10^12/L (4-5.3*10^12/L)
PCV: 37.7% (33-43%)
MCV: 80.4fl (76-90fl)
MCH: 25.4pg (25-31pg)
MCHC: 31.6g/dl (32-36g/dl)
RDW: 14.7 (11.5-15)
Platelet count: 689*10^9/l (200-450*10^9/l)
WBC: 12.4*10^9/L (4-12*10^9/L)

Differential leukocyte count:
Neutrophils: 31% 3844/ul (1400-6600)
Lymphocytes:63% 7812ul (1000-5500)
Monocytes: 3% 372ul (<1000)
Eosinophils: 3% 372ul (<700)
Basophils: ---- (<100)


Chemistry
------------
Iron (serum) 64ug/dl (61-167ug/dl)
11.46umol/l (11-30umol/l)
Ferrtin- serum 21.3ng/ml (20-200ng/ml)


---------------------------------------------------

please doctors can you advice me about his case and is it now clear that he has no thalessemia? i am afraid about his low results of iron!
what to do? continue with the maltofer till results get to a good limit?
and what is the good limit for a baby in his age?

thanks alot and sorry for writing again in same topic
 Dr. Chan Lowe - Sun Jul 12, 2009 8:24 pm

User avatar Hello and sorry for the delay in answering.

The low MCV and high RDW is suggestive of iron deficiency. In addition, the iron levels are at the bottom of normal. I think this is highly suggestive of iron deficiency. It can take several months of "treatment" iron doses to restore iron levels. It is also helpful to know that most multivitamins with iron actually have "maintenance" dose levels that will keep iron levels high once they are at that level but are not sufficient to fill up a deficit.

I would suggest that you continue with the iron supplementation and repeat labs in 6-8 weeks. Give enough time for your son to get good iron dosing or the test may not be helpful. If his iron levels are not improving he may need further testing to see if there is a reason he is not absorbing the iron. Iron deficiency is quite common and the absorption issues are fairly rare so usually iron supplementation will work.

I still believe thalassemia is unlikely; however, if there is still concern further testing could be done after his iron levels have corrected.

Best wishes.

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