Please help, need to understand my 5 year old sons results

[Ashbug17]

I have 5 year old son who has been sick a lot, most recently having fevers 3 weeks apart with no one else in the house getting sick. His pediatrician ordered a full blood work up and his results came bath with multiple "low" results in regards to WBC, B cells, T cells, and immunoglobulins. My mother and mother in law are both nurses, and after looking at the blood work, they have mentioned the possibility of leukemia. He had a bloody nose on 2 different occasions last week (he does not have any sinus issues going on right now and does not have a history of this either) has been complaining of leg pain off and on for about a year, and has been complaining every day pretty much all day if not feeling good (he says his body feels weird. The only other things he's mentioned is having a headache and feeling like the house is shaking (dizziness) about a month ago, he did have a rash in a few places that seemed to itch and if water touched it, he freaked out. My question is based on the blood work results I'm going to post below, and the symptoms listed above, anyone that has dealt with leukemia, does this sound like it could be a possibility? We have an appointment with an immunologist on Wednesday morning. Also, any help on explaining the blood work results would be helpful as well! Thank you in advance...
Glucose was high at 106
Under immunoglobulin g, the subclass 1 panel was low at 294 and the subclass panel 2 was high at 348
Under the leukocyte subset panel 1 his absolute CD3+ cells are low at 958
the absolute CD4+ cells are low at 634, the Absolute CD8+ cells are low at 292, the CD19 (b cells) is low at 9, the absolute CD19+ cells are low at 111, the absolute lymphocytes are low at 1251.
Under the CBC, the white blood cell count is low at 3.4, the absolute neutrophils are low at 1455, and the absolute lymphocytes are low at 1333.
His ANA screen was negative. I didn't list anything that was in the normal range, just the abnormal range. Anyone that can help, please, any insights would be so appreciated! I want to be educated and prepared!

[Ken_PA]

Hi for starters it should help to understand why blood cell counts can go down because of a blood cancer. Blood cells are made in the bone arrow. When bad cancer cells get into the marrow and multiply, they crowd out the production of the good blood cells. But then again, in leukemia you'd expect the cancer cells in the bloodstream to make some count on a CBC be high.

Platelets (also made in the marrow) can go low and that causes easy bruising/bleeding. But your son has a normal platelet count?

[Ashbug17]

Yes his platelet count was in normal range. He does not have a diagnosis yet but some of our family members who are nurses that work with blood disorder patients are suspicious of this being a possibility. Hence, why I am trying to understand his bloodwork and hoping those that have experience may be able to help shed some light? Everything I have read and heard has indicated low wbc can only mean a few things, that's what's so confusing and worrisome!

[Ken_PA]

Well, a low WBC can be from many things. You can, e.g., look up "leukopenia" to see various causes. What your son has doesn't quite fit with usual leukemia signs and symptoms.  

The bleeding without low platelets suggests that something else is going on - maybe dysfunctional platelets.

Being sent to an immunologist instead of an oncologist/hematologist suggests that the referring doc is thinking of an immunodeficiency (which are varied and can very much be mystery conditions). That would also tend to fit with periodic infections. The specialized tests he's had so far are not ordinary tests, and wouldn't typically be for diagnosing leukemia..

The dizziness could have been from an anemia, unless a CBC at that time showed otherwise.

So, I'd prepare for mystery and to not have a quick diagnosis - which is of course worlds better than a quick diagnosis of leukemia.

Here is something you can page through. to at least see a variety of possibilites:
http://primaryimmune.org/about-primary-immunodeficiencies/specific-disease-types/

Has he had bleeding episodes before this recent period?

[Ashbug17]

Okay wow this is so helpful. Thank you for your insight! Yes first step was to run blood work, then they did think immune deficiency, it was just several of our medically knowledgeable family members were thinking it could be leukemia so I started to research! No, he has not had any bleeding episodes prior. He is just constantly complaining of headaches, leg pain, not feeling good, and dizziness. I will definitely take a read on that link. Thank you again for sending! Any other thoughts? Tomorrow AM is his appointment

[Ken_PA]

Glad to be of help. Because of associated bleeding and rash/itch and also being male, I'd just ask the doc about the possibility of a mild case of an immunodeficiency condition called
Wiskott-Aldrich Syndrome. Just write that name down on the notebook that you always take with you to appointments. But keep in mind that immune conditions have a lot of variability within themselves and not every patient has the same symptoms. (Most with
Wiskott-Aldrich Syndrome
have low platelets, so that doesn't quite fit here.)

Good luck tomorrow. It'd be good if you can let me know what you hear.

It's also be good to know the results of a "blood smear" test where they look at a blood sample with a microscope to see if there are abnormally sized or shaped blood cells -- especially his platelets. Platelets can have  a normal count but still not work well. (A normal CBC just involves a machine to count cells.)