Cyclic Neutropenia?

[HelloAnyone]

My son is 2 1/2 years old, he is currently seeing a hematologist. After him becoming sick a lot, I requested a CBC with differential be done. His pediatrician had never ordered one for him, so they did. The first results came back as follows:

WBC- 5.5 (range is 6.0-17.0) LOW
RBC- 4.23 (3.90-5.50)
Hemoglobin- 10.4 (11.3-14.1) LOW
Hematocrit- 30.7 (31.0-41.0) LOW
RDW- 17.4 (11.0-15.0) HIGH
Platelet- 224 (140-400)
Ab Neutrophils- 330 (1500-8500) LOW
Abs Lymphocytes- 4345 (4000-10500)
Abs Reactive Lymphocytes- 385 (0) HIGH
Abs Eosinophils- 0 (15-700) LOW
.
The above results were from 7/12/2018.


7/18/2018
Abnormal lab results were:
WBC- 5.2 (6.0-17.0) LOW
Hemoglobin- 10.7 (11.3-14.1) LOW
RDW- 16.7 (11.0-15.0) HIGH
Abs Neutrophils- 1128 (1500-8500) LOW
Abs Lymphocytes- 3515 (4000-10500) LOW

Next Labs done 7/27/2018
Abs Neutrophils- 2175 (Normal Range)
Abs Lymphocytes- 2958 (LOW)
Hemoglobin- 10.8 (LOW)
RDW- 17 (HIGH)

Labs on 8/1/2018
WBC- 5.29 (4.0-12.0)
Hemoglobin- 11.2 (11.5-14.5) LOW
Hematocrit- 32.7 (33.0-43.0) LOW
MCV- 75.1 (76.0-90.0) LOW
MPV- 5.68 (6.0-9.5) LOW
RBC Dist/CV- 15.5 (11.5-15.0) HIGH
Seg Neutrophils- 19.0 (32.3-78.6) LOW
Lymphocytes- 68.0 (11.0-50.6) HIGH
Abs Neutrophils- 1.01 (1.4-6.6) LOW
Plt Morphology- Large Platelets seen

The next CBC was done 8/6/2018
I was verbally told the lymphocyte and neutrophil counts over the phone
Abs Neutrophils- 954 (LOW)
Abs Lymphocytes- 3412 (LOW)


8/13/2018
Neutrophils- 1100 (1500-8500) LOW
Lymphocytes- 3791 (4000-10500) LOW

Tomorrow he is getting another CBC ran.

He constantly has rashes. A couple of days ago he had to go to the doctor for a mouth ulcer.



The hematologist is checking for cyclic neutropenia currently with one CBC per week for six weeks.
Everything I have read says 2-3 CBC's should be done per week for 6-8 weeks.

Anyone have any suggestions for any testing that needs to be done?
Is it normal for one CBC per week (for six weeks) to be ordered when testing for cyclic neutropenia?

[Ken_PA]

"His neutrophils are normal while sick, normal lymphocytes too..."

When you get the flu, all your symptoms are from immune system chemicals, not directly from the invading pathogen. It's possible that his bouts of seeming infections are also only immune system reactions.

Monocytes can orchestrate immune reactions. Like a general telling troops what to do.

[Ken_PA]

I'd also ask if the rashes should be expected in neutropenia. If not, remember that as a possibly important clue if the neutropenia diagnosis doesn't apply. That's especially so if there is a family history of odd immune conditions separate from neutropenia.

[HelloAnyone]

His pediatrician said the rashes are expected. They ran a blood culture at the hospital. The doctor there said she is sure nothing will show, because his WBC count was healthy.  

[Ken_PA]

"Everything I have read says 2-3 CBC's should be done per week for 6-8 weeks."

Hi, for starters, I'd think that what you need is an 'authoritative' source. My guess is that this one qualifies, since it is from ASH: It also gives the reason, which seems logically very valid. (I don't see a date on it, though.)

"It is imperative to establish the diagnosis of cyclic neutropenia by serial differential white counts at least 3 times per week for a minimum of 6 weeks to observe at least 2 neutrophil nadirs."
http://asheducationbook.hematologylibrary.org/content/2012/1/174.full

So you might ask the hema why they are doing differently. It might be because your child hasn't been proven to have the gene mutation at his point.


However, if it looks that the hema seems not-too concerned, maybe that is because of something like this from Medscape:

Pediatric Autoimmune and Chronic Benign Neutropenia Differential Diagnoses

https://emedicine.medscape.com/article/954781-differential

"Acute transient leukopenia and neutropenia in small infants and young children are extremely common."

and

"AIN of infancy usually lasts at most 2-3 years before spontaneous resolution. If it persists beyond age 4-5 years with a benign course..."

But all that with children is outside of my sphere, so I really don't know. Children generally have exaggerated immune reactions because their immune systems are still forming.


Btw, I also don't see very low abs neuts. Again, from ASH:
"The risk for infection in the disorders of neutrophil production and release is greatly increased, with counts of 500-200/μL, and is very severe below 200/μL. "That might make you feel a little better.

[HelloAnyone]

Thank you very much for the replies. He was sick (low grade fever and super runny nose) and had a CBC ran. His neutrophils are normal while sick, normal lymphocytes too... but monocytes are slightly increased 1.5 (0.3-1.2) 16.3% (3.5%-13.9%).  His eosinophils were borderline 0.2 (0.0-0.2).

[HelloAnyone]

I am going to ask the hematologist why she is only running one CBC per week, if she is testing for cyclic neutropenia. I am no expert, I am sure she has her reasons. :)