My son is going to see a hematologist after he had several labs done that came back abnormal. I dont know what the actual results were, but they did tell me his white count was high, his pt,ptt was high or abnormal and his bleeding time took too long or longer than normal. The reasons for the test to begin with is his tendacy to bruise. At the same time he was sent for lab work he had just been diagnosed with MRSA on was on clyndimicin, couldnt that have affected his white count?? Also whenever my son gets really upset, for instance when he has to gets labs he literally freaks out, it takes about me and 3 lab techs and usually about 30 minutes plus to get his blood. He screams, tightens his body, turns blood red, chokes hiself until he almost throws up and fights with all his strength the whole time, usually one of the techs has to start fanning him. After the blood is finally drawn, (which by the way his blood takes forever to come out every time and he has to be stuck in a lot of places before they finally get it) and his blood red appearance starts to fade he is broke out all over his face ( very badly around his eyes), chest, arms, legs and sometimes other places with what looks like pin sized red marks. It actually looks like someone stuck him with a needle all over. I have read that this may be petechiae. My question is although I realize there may be a serious problem causing the abnormal labs, I also have to wonder if the MRSA or the high amount of stress he is under while labs are being drawn could cause his white count to be high, his pt,ptt,factor 8, etc to come back abnormal?? Is that possible?? By the way he has had recurring MRSA 3 times within the last year. Any help or advice would be greatly appreciated. Tahnk you
Two things come to mind. One is that the primary problem rests in the white blood cells. If there is an abnormal population of white blood cells continuously rising (such as in leukemia), the bone marrow space for other blood components gets used up. One of these blood components are platelets. If there is a low platelet count, there is a tendency to form those little red dots that appear after you restrain your son during blood extraction. These are likely petechiae. To pursue this problem, a thorough examination of the blood will be needed to determine if it is leukemia. Bone marrow may also be required. Bruising is not generally a function of platelets to prevent, but are a function of clotting factors. Clotting factor functionality is measured using protime, thromboplastin time. Abnormal white blood cells, can secrete substances that promote clotting factors to get clumped together reducing their absolute number. The problem of platelets may be due to underproduction. The problem of clotting factors is likely they are produced, but are incorrectly spent by the body, so where a traumatic bruise shouldn’t appear with gentle handling – it does. The problem of MRSA stems from an inadequate response of the white blood cells. The White blood cells function primarily to fight infection, and if the population of white blood cells is dominated by abnormal ones, these cells do not perform the job of fighting, hence, infection comes and goes.
The opposite scenario is also possible. A severe MRSA infection can emerge simply because a 2 year old may not mount a sufficient immune response against it. The white blood cell counts rise normally in order to fight off the infection. The severe infection triggers platelets and clotting factors to get used up producing the petechiae and bruises.
Some critical questions: how high was the actual count? Does the count have a breakdown of white blood cell categories both normal (polymorphonuclear/segmenter/granulocyte/band/eosinophil/basophil/lymphocyte) and abnormal (blast)? How long has been the duration of illness (the shorter, the infection is more likely, the more protracted the chance of malignancy is greater)?
Sadly, be prepared that there is a distinct possibility that no specific disease may come out of the work-up despite all these symptoms. This is because some blood diseases tend to evolve over time, and the definite clues to make solid diagnoses may be elusive in spite of the obvious problems.
Thank you so much for your response. Hopefully we will get some answers on Tuesday when we see the hematologist. I did call his ped. dr. the other day mostly because i was worrying so much, and she told me that they really didnt think it was luekemia, but that there are other "benine" type issues that could cause the abnormal labs and other problems my son is having. I will prepare myself for a long haul to find out what is wrong with my son, but I am hoping that we may know something quickly, thats what I pray for. I will let you know what we hear on tuesday. Thank you.
Hi, we wnt to the hematologist appt on tuesday. Basically we didnt get any real answers yet, they wanted to do a repeat of some labs and a whole new set of labs which include blood typing abo,prothrombin time/inr, factor viii activity assay, factor viii ristocetin cofact, factor viii vw factor antigen, fibrinogen activity,thrombin time plasma, platelet function analysis and auto hemogram/plate/diff. I believe the last 2 i mentioned were the ones she called me back with results today, she said his white count was good and his platelet count was high, i believe she said in the 300,000s (i may be wrong), she said his platelet count was good though, the only problem was that his platelet function was abnormal, not working properly I suppose they meant. So she said she was going to talk to the hematologist and see if they wanted to do that test again or wait until we get all the other labs back which she said would probably be back at the end of next week. So still no real answers. Honestly I find it all so strange since we have really done some checking with family members to see if there is a history of bleeding disorders, (which the hematologist explained most are inherited) and we have yet been able to find any real issues other than some cases of anemia on both sides of the family. So really I am still confused, i mean I have read up on all of this as much as possible and other than the bruising, my son really seems to have none of the other symptoms that come along with these bleeding disorders, even the hematologist had mentioned that. So I have to wonder if there could be something else other than a bleeding disorder causing the so far abnormal labs, like the abnormal platelet function. I guess we wont know more until the other labs come back. The hematologist said that if all the labs come back normal that he wont have to return for another visit which is scheduled for december 21st. That of course kin of worries me though since even if the things they are checking for come back normal, what is causing his abnormal platelet function. I woryy that if those other labs come back normal and i dont return for another appt, I still wont know why the platelet function is abnormal, so who do I turn to then, back to his ped Dr.?? oh by the way, after we saw the hematologist on tuesday that evening my son started running a high fever 103 plus over the next 24 hours, he went to his regular dr. today and he has strep throat and a rash on his body. Could it be possible that when he had his labs drawn tuesday afternoon the illness was already there and could that have affected his plaelet function??? Of course his white count from the same labs done that day came back normal, in fact well within normal range she told me. I am just so confused, it seems like since he was a little baby he has just gotten so sick all the time. He has ezcema, lots of ear infections, which led to him getting tubes, hes always getting viral type illnesses which many of the times when hes had them he breaks out in rashes all over his body (the doctor said that is normal with many virisus) and of course the several times with the MRSA. Dont get me worng I count my blessing that all these times his issues have been minor in comparisson to the issues for other families. I just wonder why he gets ill so much, I have 3 other children all girls and none of them ever get as sick as him or have. I just wanted to update you on what we know, if you have any new thoughts please, please respond. Thank you
Your worries are pretty understandable, because no specific diagnosis has yet been proposed. Platelet dysfunction is still pretty vague - several reasons may stem from them, both from a blood abnormality and an extraneous cause such as infection. Blood abnormalities that are primarily involved with platelets are not really associated with an increased tendency to acquire infections - so if it turns out to be this, then it may simply be because of his age that he seems prone to illness. Risks of infection for people with platelet-disorders would stem more from infections acquired through transfusions (I'm under the impression that your son has never underwent one).
If we would explore the propensity for infections, there are diseases of the immune system which are congenital and may explain the history of MRSA. However, most of these cases would involve a lower platelet count or abnormal looking platelets (which are not present in your son).
On the question of a doctor to see if the hematologist feels there is no blood disease, you may consider seeing an infectious disease doctor.
Hope this has been somewhat helpful.
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