Pediatrics/white blood cell level keeps going up (30,000 - Katie - Cyprus)
Dear Dr. Olson!
Asking for your help from Cyprus again: Please, couldn't you be so kind as to comment on my 21-month-old daughter Katie's follow-up blood test (taken on 12/30/13 -attached). Her white blood cell levels keep going up: WBC 29.20, as well as PLT 489, NEUT 12.64, LYMPH 13.38, LDH 962...
Currently, she's generally ok, very active. Just a little runny nose and some mucus cough sometimes. Early in December she had an ear infection with fever (treated with Moxilen Forte), followed with a throat infection with fever (treated with TRICEF - Cefixime).
Please, Doctor, if you think it's something serious, maybe you could refer us to some pediatric hematologist you personally know, who could check her blood tests and advise us on treatment. I could pay by credit card for such a preliminary online diagnosis & if treatment is necessary, maybe, we could come to the US, wherever you refer us to.
Waiting anxiously for your reply!! Thank you very much in advance for all your help! Our best holiday wishes to you for the new year!
Reviewing the labs, the gammaglobulin A levels are low, suggesting an IgA deficiency, a rather common immune deficiency that can cause frequent infections and these infections, mild as they may be, can cause an increase in the WBC. The LDH is high and the urea was high, suggesting some mild liver dysfunction and that she may have been clinically a bit dry when she had this test done. I would suggest a visit to a peds hematologist. I have no idea who you have access to, but to me, coming to the USA when you have fine doctors much closer, doesn't make a lot of sense.
You need someone to discuss this with you, carefully review the lab values, get a good history and do a good exam, and then determine if further tests, like a bone marrow exam, need to be done. This can't be done sufficiently in this format. I am always happy to help.
Good luck, Dr. Olson