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Does declining CBC matter, or only once fully out of range?
Blood Cancers & Disorders | Last Active: Jul 13 8:49am | Replies (14)Comment receiving replies
Hi @lorenzom, After taking a look at these numbers, I’m not sure a hematologist would be able to offer much more input at this time…though a consultation would go a long way to ease your mind with covering all the bases in trying to find the cause of your daughter’s illness.
Your little girl is on some strong antibitotics and medications and she’s been fighting infections all along this past year. It would not be unexpected to see skewed blood results with her continued infections and inflammation. There are also certain drugs, including some antibitotics which can reduce neutrophil counts. The white count and the neutrophils being suppressed could speak to either an autoimmune or inflammatory issue. I can understand why her rheumatologist is suggesting an active surveillance period.
There does seem to be an overall downward trend in her blood numbers. But you’re seeing peripheral blood results which could be looking more at effects than causes. A bone marrow biopsy could offer a more definitive picture regarding what is going on with her bone marrow, if anything. But that may be premature at this point. However, a peripheral blood smear, if it hasn’t already been done, might be a consideration. This test can tell the doctor about the health of the blood cells while looking for any changes in the number and morphology of her circulating blood and platelets. But certainly a hematologist would be able to give you the best advice as to whether this is warranted at this time.
Has she had a peripheral blood smear?
Replies to "Hi @lorenzom, After taking a look at these numbers, I’m not sure a hematologist would be..."
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Thanks again. I agree with the necessary wait-and-see, though I am hoping there's a bit of a shortcut as she'll start kindergarten in less than 2 months (or at least we'd like her too). Thursday morning we're take her to a specialist eye hospital because her eyes are excruciatingly painful, yet 3 local ophthalmologists all differ and their opinions and treatments.
A blood smear has never been ordered. Of course in my researching this week everything indicates a blood smear is sensible (and cheap and easy), so I'll ask they tack that on to her latest lab order. At the moment, we're redoing labs (and adding a slew of new ones) at the end of July, so it's not an overly long wait (if the eye pain can be lessened at least).
If you don't mind me asking, in your experience is it well received by doctors for a patient to suggest adding a test (the blood smear), they don't particularly care, or it can strain a relationship (doctors are human)? I'm never hesitant to do so during an office visit, though at times I feel a bit "shy" to do so by messaging. I guess I don't want to be steering things too much, but then again I've had to vigorously do so to get us to the point we're at already ... the understandable response for the first year was "kids get sick often", but that changed drastically as soon as I pushed and her first immune tests came back very worrisome. It's like there's an imaginary line I feel I can't cross too often, crossing from the allowable patient's strong advocate into the undesirable 2nd-guessing parent who won't take advice.
And truly, sincerely, and with all my heart thank you for your help! Clearly you know from experience but you also are obviously very intelligent and kind. Your remarks about peripheral vs marrow alone closed the loop for me on some items I might have been misunderstanding previously.