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Pediatrics/Strange blood work for a 21 month old


My son had a liver transplant at nine months old due to biliary atresia. He also has heterotaxy syndrome, and polysplenia. He is now 21 months old. He takes prograf (anti rejection med), Bactrim (for no spleen function ), Zantac, and iron. He's had chronic diarrhea and had blood in his stools since June. They began iron treatment for low iron in October (after two scopes upper and lower with biopsies each time) that gave no reason for the loose stools or blood. Liver wise things are good. Constant issues with ANC dropping off and rebounding within a day. Very high IgG... He also has portal vein thrombosis, but has no issues (no high blood pressure or functional issues with his liver) due to it. Any ideas doc? I'd really appreciate another opinion.

IgG:   2387   mg/dL   4001300

**ESR (Erythrocyte Sedimentation Rate): 27mm/hr    020
**C-Reactive Protein: 0.96 mg/dL
Lipase Level: 8    unit/L    760
**Amylase Level: 38 unit/L    40220

**Microcytosis, RBC: 2+   
**Hypochromasia, RBC: 2+   
Left Shift: Absent   
**Absolute Eosinophil Count: 0 K cells/uL   0.030.29
**Absolute Lymphocyte Count: 7.37 K cells/uL   2.325.49
**Absolute Neutrophil Count: 0.2 K cells/uL   2.476.41
RBC Morphology: Yes   
**Neutrophil/Band: 2 %   2369
**Lymphocyte: 73 %   1567
**Monocyte: 11 %   410
**Eosinophil: 0    %   15
Basophil: 1 %   01
**Atypical Lymphocyte: 5    %   04
Poikilocytosis, RBC: 1+   
Elliptocytosis, RBC: 1+   
Burr Cells, RBC: 1+   
**Tear Drop Cells, RBC: 1+
**Target Cells, RBC: 1+
Helmet Cells, RBC: Rare to 1+   
Spherocytes, RBC: Rare to 1+

WBC: 9.39 K cells/uL   7.7313.12
**Hemoglobin: 8.5 g/dL   10.412.5
**Hematocrit: 27.9%   30.536.4
**Platelet: 479   K cells/uL       223461
**MPV: 9.1 fL   7.38.1
**RBC: 3.81 M cells/uL   3.814.74
**MCV: 73.1 fL      75.683.1
**MCH: 22.3pg   2629
**MCHC: 30.5 g/dL      33.635.2
**RDW: 21.2%   13.615.5
HDW: 2.83g/dL   2.763.36

Hi, Michelle,

Whoa, Michelle, this is well beyond my humble pediatric generalists pay grade!  I'm sure you have a bunch of pediatric hospital specialists hovering over your child, and questions like this are impossible for me to address, do to the complexity and the lack of all the information that is needed.  Ask your primary care pediatrician about this to see if any of the specialists have some ideas.

Sorry I can't be of more help to you, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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