10 month old with elevated platlet count

I am looking for someone that may have experienced the same symptoms as my 10 month old son.  He was diagnosed with a virus 14but days ago which presented with high fevers, congestion, cough, and O2 stats of 86%...he was hospitalized for 4 days due to ddecreased O2 stats. When he was released all symptoms were gone except fever. His fever continued for 12 days. Day 12 his pediatrician referred him to an infectious disease specialist and did blood work.  His platlets were elevated to 935,000 and low hemoglobin and hematacrit levels.  Day 14 fever is gone for 2 days and labs repeated.....platlet increased to 1,134,000 and hemoglobin and hematacrit decreased even more. Now infectious disease doctor does not want to see him due to no fever and now refered to hematologist who is having labs redone in 4to days with added bone marrow test (not aspiration). I asked physician what could be going on and he does not want to give answers until they know for sure what is going on. I need some answers before I go crazy. Any idea what may be going on......anything?? Please help!!

[Ken_PA]

Hi, I'd guess that was is happening is most likely as follows: your son got the virus infection, then next either the virus or his very strong immune reaction is killing of his red blood cells. Next, his system detects the drop in RBCs and reacts as it would if the loss were due to bleeding: by producing lots more platelets (whose job it is to help stop bleeding).

So this would be a "reactive thrombocytosis", as his system is reacting to the RBC destruction (hemolysis).  Thrombocyte is another name for platelet. The inflammatory chemicals set loose by his immune reaction will cause more thrombocytes to be produced.

It's also possible that too many platelets get produced because of a cancer  in the cells (megakaryocytes) that produce platelets in the marrow. I'm guessing that your son's marrow test will turn out okay. The reason is that his age is wrong for a marrow cancer (myeloproliferative disorder); and also that the platelets produced by a marrow cancer usually don't work right -- therefore they produce bruising and bleeding, or else produce excess clotting. But your son doesn't have either of these effects of malfunctioning platelets.

So, I think that the marrow test will be good, and you have reason to think the best at this point :)  Good luck.

http://www.merckmanuals.com/professional/hematology_and_oncology/myeloproliferative_disorders/essential_thrombocythemia.html#v974136

[Ken_PA]

P.S. It would be nice if you could post back with the end results once you know.

[momofaka]

Thank you Ken for your reply.  This gives me hope that my baby will be okay.  I will indeed post the outcome.

[momofaka]

Still no answers but this is what the test showed today...platelets decreased from 1.1 million to just under one million, hematocrit increases slightly and hemoglobin increased slightly (on doctor didn't give me exact numbers but I will be getting copies tomorrow....and the bone marrow test showed elevated reticulocyte?? Which I know are immature red blood cells but still don't know what all of this means.  Needless to say, I am still worried sick!! He is being referred to a hematologist this week.

[Ken_PA]

Hi, that looks like good news to me. His RBCs are undergoing less destruction and the elevated reticulocyte count shows that there is no problem with production (which tends to say that there is no cancer in the marrow).

What about his white blood cells? (WBC)  and lymphocytes?

[momofaka]

His wbc have now dropped into the normal range and I am not sure the lymphocyte range.  So now I ask why are there elevated number of immature red blood cells but the hemaglobin and hematocrit are still low?? My pediatrician is not the best at explaining. And do you think this could still be resulting from the virus he had (he has been symptom free for 8 days)? I am truly thankful for your imput :) You have a nice way of explaining. And if you don't mind, may I ask are you a doctor?

[Ken_PA]

hi again, and thanks for the compliment. I'm glad to have been of some help; but no, I'm not a doctor.

"why are there elevated number of immature red blood cells but the hemaglobin and hematocrit are still low?"

likely just because the process of replenishing the RBCs takes time. (Also, anything about all of this may vary from what I'd expect because of his young age.)

So... RBCs are made in the marrow, starting as reticulocytes. The reticulocyte count (blood test) is therefore a test of marrow function, without actually drawing anything out of the marrow.

Since his reticulocytes are elevated, that indicates his marrow is working overtime, like a busy factory. I'd think his Hbg and hematocrit are catching up now little by little. Once caught up, the reticulocytes should go back to the normal level.

It's even possible that for a while the virus was suppressing production of RBCs in the marrow, but you might never know that now. The other possibility is that the virus resulted in destruction of RBCs (called hemolysis). Or... both processes together could have resulted in the low RBCs.

I suppose it's possible that the virus was wiped out everywhere, except there were some still in the marrow - and that's why his fever was gone but RBC measures still declined for a while.

Since the WBCs have declined to normal then that likely means the virus is defeated. However, his immune system has now been educated about that particular virus and he should be much better able to wipe it out again if the need ever arises.

If there had been a rash, then the suspect virus (in children)  might have been "Parvovirus B19". But you didn't mention a rash.