abnormal blood test parameteres

[scarlet27]

My 4 year old daughter has the following "off range" parameters.

MCV 70 (low) Normal Range (78-102)
MCH 20,8 (low) Normal Range (27-35)
RDW 18,5 (high) Normal Range (11-14)
HGB 10,1 (low) Normal Range (12-16)
HCT 34 (low) Normal Range (36 -49)

She takes iron last time feritin was tested was borderline
She had the hemoglobin test for the Thalassemia trait 3 times, it was negative the first two times and non conclusive the last time. We were told to do DNA testing. We had that done in one lab and it was negative, we will repeat it.
I am starting to worry, if its not the trait or anemia,
could it be cancer or leukemia???
Any suggestions?
Thank you

[Hien K Duong, MD]

Scarlet27,

I apologize for my late response.  Unfortunately, I only see adult patients and may not be able to give you very useful information regarding your daughter - but will try.

What were her other lab parameters?  Do you know what her white blood cell count or platelet count were?  Also, what kind of symptoms does she have - how was this initially detected in her?

  

[scarlet27]

Thank you for the respond.
Her complete latest exams (she was taking feritin for six months) were:

Parameter Value     “Normal” values     Value%      “Normal” value
WBC 7,9 K/ul 4,5 -13,5
NEU 4,29 K/ul 1,5-8 54,3 40-75
LYM 2.62 1,5 -8 33,2 11,8-45
MONO                       0,679              0 -0,9 8,6 1 -15
EOS 0,243 0,1-0,4 3,07     0-10
BASO 0,07                 0 -0,1 0,881   0-1

Parameter Value Unit Ref.
RBC                            4,87               M/uL 4,1-5,5
HGB 10,1                g/dL 12 -16
HCT 34                    %                    36 -49
MCV 70,9                fl                      36-49
MCH                           20,8                pg                     27 -35
MCHC                         29,4              g/dl                    31-37
RDW                            18,5                 %                    11-14

PLT 436 k/μl                150-400
PCT                            0,273                  %                 0,12 -0,32
MPV 6,27                   fl             6-9,8
PDW 17 % 15 -17

Also in morphology it was noted
Anisocytosis +
Hypochromia +

And
HBA2 2,5 %
HBF     1,7 %
Feritin 14,9 ng/ml

In previous exams (no iron supplement), another lab I don’t have ref. values she had:
Hb 11.0
RBC 4.77
PCV(%) 33,5
MCV (fl) 70,2
MCV(pg) 23,1
MCHC (g/dl)    32.8
RDW-CV 14.8
HB F 1.8 %
HB A2(%)       2.5/2.5 %

H bodies        not found
Film:
Hypochromia ++
Anisocytosis ++
Poikilocytosis +
Mircrocytosis ++
Target Cels        +


Inclusions
Zpp(μmoles) Zp/moles Heme 113    Normal Range (60-80)

And at the same lab she had the DNA test for Thalassemia mutations
α-genotype – she was normal for 10 α-thal mutations
(Which makes me realize – she never had a DNA test for the other genotypes! (β-genotype or δ-genotype...
The genotypes she was tested were: α3.7, ααα, MED I, α20.5, α5nta, Agr, αpolya2, αpolya1, MEDII, α4.2, Ikaria) and were all N/N
With results αα/αα

The reason we started testing her was because in previous blood test we did when she was sick (she had frequent infections from 1.5 till 3.5 years old) she had either high or low neutrophils and her pediatrician suspected she might have cyclic neutropenia. She referred us to a hematologist who told us to have CBCs weakly. Those results were interpreted as “normal” for neutrophils but the values of MCV, MCH, MCHC, etc. are more or less the same. (it is confusing for me but the lab we had this had different ref. values and seemed that these weakly tests she had slightly high neutrophils, mono, and eos (i.e. neutro was 45 % with lab ref. values <33%). We were told after those test to give iron supplement which we are still doing. Also before the iron supl. she got tired very easily, the iron helped a lot with this.
Other tests the hematologist had us do were:
(I am translating here and I hope I get it right)
Normal Range
Total B cells CD19 22 % 6-22
Total B cells CD20 20 % 5-18
Fc-receptor IgE CD23 none 0-15
T-cells (E –receptor)   CD2 70 % 65-85
Thymocytes CD7 none
Total T-cells CD3 67 % 56-80
“auxiliary” T-cells      CD4 52 % 31-64
T cells CD8 18 17-38

She had biochemical tests, everything was “within range” exept
LDH        272 Ul/l with normal 0-248

And she had these “anosiology” tests
IgG 8.71 g/L
IgA 0.482 g/L
IgM 1.23 g/L
IgE 59 IU/ml
IgG1 6.02 g/L
IgG2 2.1 g/L
IgG3 0.207 g/L
IgG4 0,856 g/L

The above values were characterized as normal

I am not a doctor of course (I am a chem.. engineer) but it looks like something is wrong, and if it is not thalassemia trait then what?
Thank you for taking the time to read this!!!