Neutropenia

[mrsconradfisher]

Just posting on the off chance that someone with more medical knowledge than me could help.
DS is 15 and usually very healthy. He had a severe sore throat, worst I’ve ever seen at the start of December. GP diagnosed strep throat and he had 10 days of high dose antibiotics. GP also advised blood test as they were wondering about Glandular Fever as he was so incredibly poorly.
Had blood test done at the end of December (first appointment I could get) and got the results back yesterday. It’s confirmed he had Glandular Fever.
Blood tests also showed he has mild neutropenia. His neutrophil count is 1.48 and they should be between 2-7. His lymophocyte count is also raised at 3.53 and it should be between 1-3.
I know logically it’s just his body still fighting the infection but his best friend got diagnosed with Leukeumia 18 months ago and I’m just freaking out a bit. GP wants a repeat bloods in a couple of weeks and then will investigate if necessary.

I think it's a sensible plan to repeat the bloods. However, he has a known infection and you don't mention any weightloss, bruising or night sweats so it does sound like it's related to his illness.

Children have a lower neutrophil count and higher lymph count than adults. This changes at some point in their teens and the numbers reverse. Could be his repeat blood test will reflect this change.

One of my children (4) had this after being admitted to hospital with flu in October. His neutrophils were 0.4. They did some more tests on the sample and there were no blast sites which I think is what they use to rule out leukaemia, and they had already done that before they told me the initial blood result. We had a retest 4 weeks later and his count was 3.5, so still low but on the up. I was frustrated as I’d wanted a retest after a week because I was worried about him going to school with those levels but it is better to give them a chance to come back up. My ds has no trouble with bloods so I would have liked weekly for 4 weeks to be honest but there was no chance!

Thank you. Yes I suspect it’s just the infection but that was 6 weeks ago now so I would have expected it to normal by now but it’s probably just taking it’s time.

His friend had no symptoms either, no bruising, no weight loss. Just suddenly felt awful and his mum took him for a blood test at GP request. I was with him the night before and he didn’t look great but nothing that you would immediately think he had leukeamia. He was admitted within a hour or so of the blood being taken. I know logically it’s not that but when you have seen first hand what they have gone through it’s easy to think the worst.

Ah that’s interesting, thank you.

Oh wow that is incredibly low, did he feel unwell also?
DS isn’t right, nothing I can put my finger on but he’s just not himself. He plays 2 sports to a very high level and he is just exhausted so hasn’t really played. His mouth/tongue have got lots of ulcers. And he is sleeping so much. But appreciate that’s probably just the after effects of the glandular fever.
It will be 4 weeks when they retest so hopefully they will have come up a bit by then.

Yes he was really unwell, I was very worried about him and scared to send him to school in case he caught anything else. We all had a very quiet half term at home! I didn’t give him the flu spray either because we had just had flu (which was confirmed by swab when he was in hospital) and I was frightened to give him the live spray after that! Found it tough to get answers over what to do about that, just kept hitting a wall of ‘well it might have been a different strain’

It does sound like it’s related to the glandular fever, someone recommended probiotics to me, a multivitamin and plenty of iron rich food, although I guess that’s pretty generic advice for someone who is unwell!

Oh also, my eldest also does a sport to a high level and he took a long time to get over flu, the post viral fatigue was real (it was my middle one with the neutropenia) so that’s probably pretty normal too as I guess flu and glandular fever are fairly similar in that way

I wouldn’t be concerned. I was diagnosed with autoimmune neutropenia after being referred to haematology and loads of bloods etc
my symptoms were constant infections and always unwell. Was 0.3 at diagnosis and they’re happy now if mine are over 1.5
I do have to inject a medication weekly

Honestly, this is normal for glandular fever. It can take a while for the levels to go back to normal, so get the tests repeated on a couple of weeks to keep an eye on them.

My son is about the same age and was very poorly with GF in March and April last year. He’s still really struggling with the fatigue. It takes a very long time to recover so do make sure that your DS is resting enough and has extra time off school if he’s still suffering.

Have you got any other blood tests to compare it to? My neutrophils are almost always a bit below the reference range. Eosinophils always slightly above the range. One of my DC had a blood test the other day (his first) and the pattern was the same. This may be your son’s normal.

That’s a really good point actually. It’s the first proper blood test he’s ever had taken so there is nothing to compare it to. I say first proper blood test as he was premature so he obviously had blood taken then but nothing we can actually compare it to now.

Thank you. I think I was possibly expecting him to just bounce back as he is normally so fit and well. So far apart from the time he had off school, he’s managing school ok but just comes home and lies in bed (which is not normal for him). I haven’t actually told school but will email them this morning. Hopefully the next set of bloods will look better.

Definitely tell them - they can put measures in place to support him then. My son’s school were excellent with him and allowed him to more or less come and go as he pleased based on how he was feeling physically (he’s a responsible lad so we all knew he wouldn’t take advantage of it and alive off all the time). He also got an extra 1.5% in his GCSEs because it impacted him so much. Try not to worry about him just lying in bed after school - he will be absolutely shattered and the only way to heal from glandular fever is to rest as much as possible. He also can’t play any contact sports for a while due to the risk of spleen rupture.

That neutrophil count is perfectly adequate from normal life. It only gets worrying with a count of below 0.5. He will be fine. DOI medical doctor

Thank you, really appreciate it!

How long does the fatigue lasts and does it come back with sore throat and flu season?

after glandular fever? It can be 18 months or so and it often gets worse along with cold and flu season. After 18 months it’s more likely to be ME CFS which can be triggered by GF or other viral illnesses.

So just coming back to this thread. We are now 3 months post Glandular Fever. After the initial blood test which confirmed glandular fever, he’s had 2 more blood tests each a month apart. They are concerned because his neutrophils are still low and getting lower with each blood test that he has. Last one this week, they were 1.2. They have said he needed 3 “dodgy” blood tests before they investigate further and this is the 3rd one. I know logically it’s “just” the Glandular Fever but I’ve got this niggling doubt that there is something else going on. GP is calling me Monday and I just want to be armed with information. I assume he’s likely to want to refer us to Haemotology?
Honestly I’m normally the least worried Mum when it comes to his health. He has a very rare heart abnormality, was born premature and has had countless operations when he was tiny. I’ve never been worried like this but something is telling me that to push for further investigations. I knew there was something wrong with his heart but they told it would never in a million years would it be that and lo and behold it was so I’ve learnt to question if I feel something is wrong. This time I just don’t quite know what it could be.

There’s a few things it could be really, neutropenia has a lot of causes
mine is autoimmune so I kill mine off (helpful!)
they were panicky when I wasn’t diagnosed and they were 0.3, but they rarely scrape over 1.5 now and that’s on a good day
it’s hard to say don’t worry but my life is fairly normal apart from doing my injections and being immunocompromised

Just coming back to this again if anyone is remotely interested. GP ordered another blood test and it’s dropped even further so he asked my DS to come for a face to face appointment (practically unheard of!!) as he was worried his spleen was enlarged. We were with him about 30 minutes and he literally gave him a full mot, checked his spleen, liver, lymph glands, BP, heart and something else which I can’t remember! He thinks that there could be 2 things going on which is confusing the situation. He said the neutrophils might just be incredibly slow to pick back up again after the GF or it could be that his “normal” neutrophil count is low anyway and we wouldn’t know as the first blood test he’d ever had was at Christmas after the GF. He said very rarely GF triggers an autoimmune response of some sort and seeing as both I and other family members have several auto immune conditions, he wants to investigate that. So he’s ordered another blood test to included B12 and thyroid. He’s also going to speak to heamotology and get some advice. Just feel glad that he’s taking it seriously. I can’t put my finger on it but something just doesn’t feel right.

How is his diet?
my kid had very low iron so was on iron tablets. But also had low wbc. So i also gave her multivitamins with B vitamins in. And it had gone to the normal range on the retest.

How is he feeling physically? Is he still struggling?

His diet is fairly good, well for a 15 year old boy!! He plays a lot of sport so eats fairly healthily, steak features quite a lot, chilli/spaghetti with 5% mince. Yoghurt bowls with lots of seeds and fruit. He loves salad but isn’t a fan of cooked veg so I suppose he could up that a bit. Only thing he won’t really eat is fish.
He has got some multivitamins but I almost want to see what the levels are like when they do the blood test before he starts taking them.

Yeah he really isn’t himself. He is just exhausted but no amount of sleep is helping. We went out today for a meal (belated Mothers Day as my oldest DS came back from Uni) and a walk at the coast and he slept all the way home in the car. He is normally a Duracell bunny, would do a whole day at school, play footy at lunch, come home, go to gym then go to football then still have energy. The only other weird thing is his face is sort of slightly puffy. Not massively and no one else has noticed but side by side photos from November to now and it does look different. Feel like I’m searching for a needle in a haystack as it could be anything or it could just be the after effects of the GF.