AYSAM MAZEH BLOOD RESULTS

AYSAM MAZEH
BLOOD TEST RESULTS
 
 
HEIGHT                                             89
 
WEIGHT                                            130 800
 
BODY MASS INDEX                             17.4
 
BODY SURFACE AREA                         0.58
 
 
 
 
LIVER FUNCTION TEST                                                                                           
 
 
 
bilirubin total                  5
 
bilirubin (conjugated)   2
 
aspartate txaminase     80
 
alanine txaminase          134
 
gamma-glutxferase        16
 
alkaline phosphastase         165
 
 
ca/mg/phos
 
calcium         2.48
 
MAGNESUIM       0.76
 
phosphours     1.81
 
 
 
FBC
 
HAEMOGLOBIN       100
 
WCC                              19.3
 
PLATELETS             385
 
HCT                         0.29
 
MCV                   79.0
 
MCH                      27.0
 
T&b
 
LYMPHOCYTE COUNT    9.20
 
 
CD3  T CELLS                        5.15*
 
 
% CD3 T CELLS                    56
 
 
CD4 T HELPER SUBSET          3.22
 
 
 
% CD4 T HELPER SUBSET           35
 
 
CD8T SUPPRESSOR SUBSET            1.75
 
%CD8 T SUPPRESSOR SUBSET          19
 
 
CD4:  CD8 T CELLS                         1.84
 
 
CD 16/56 NATURAL KILLER CELLS           0.46
 
 
%CD 16 56 NATURAL KILLER CELLS           5
 
 
CD 19 B CELLS                                    3.56
 
 
% CD   19 B CELLS                              39
 
 
 
ATYPICAL LYMPH                        0.4
 
BLOOD FILM
 
 
NORMOBLASTS / 100 WBC            4
 
 
 
TOXIC GRANULATION                    +
 
 
ANISOCYTOSIS        +
 
 
POIKILOCYTES                    +
 
 
POLYCHROMASIA                    +
 
 
OVALOCYTES           
 
 ROULEAUX                     +
 
FRAGMENTED CELLS            +
 
 
TARGET CELLS             
 
 
COAGULATION-PLASMA
 
 
 
PLASMA PROTHROMBIN TIME     14.1
 
INR                 1.0
 
APTT             30.7 *
 
FIBRINOGEN         2.7
 
 
 
 
IRON STUDIES 
 
 
 
 FERRITN        3723     DONE 13 AUG  08
 
BLOOD TRANSFUSED 14 AUGUST 08 SO MUCH HIGHER NOW
 
 
SEND AWAY    FERRITN LEVELS 1995
 
GLUCOSE       4.9*
 
ALBUMIN         50
 
GLOBULIN   25
 
 
A/G RATIO    2.00
 
ANTI TTG ANTIBODY     2*
 
ANTI TTG ANTIBODY INTERPREATION   TTG ANTIBODY
 
 
VITAMIN C           57
 
 
CAN ANYONE TELL ME ANYTHING MOST OF MY SONS RESULTS HAVE A (H ) BESIDE THEM WICH MEENS HIGH

AND THEY TELL ME NOT TO WORRY HE WILL BE FINE  CAN ANYONE TELL ME   WHAT ALLL THESES MEEN  IS MY SON IN DANGER PLEASE 

Mariam,

I have sent a copy of his results to a thalassemia doctor in the US.  Please be patient as I await his response.  I wish I could give you more, but I am not sure what to tell you yet. 

I will respond as sooon as I get a response,

Sharmin

Mariam,

The things that stand out to me are  the high liver values (ALT & AST) and the low mineral levels (calcium etc.) The liver values may be a result of his high ferritin and it needs to be addressed. The higher Exjade dose may get the iron to level off but probably isn't high enough to cause much of a drop. Has Asyam ever had desferal administered by IV? I would like to know if he has a bad reaction when taken IV, rather than subcutaneously in his abdomen. If he can tolerate desferal through IV, it can be used to get his ferritin down. Sometimes patients are given IV desferal 24/7 for as long as 7-14 days and it causes a drastic reduction in desferal. However, patients using this method usually have much higher ferritin levels, so the doctors may not want to choose this method but rather try the Exjade route first. Dr. Wood said to go to 250 mg (20 mg/kg) and then go up in 5 mg/kg increments at a time until 30mg/kg is reached if necessary. One thing is, you have to have some patience. The optimum dose has to be gradually reached and it will take time to find what the correct dose will be. Serum creatinine levels need to be regularly monitored.

Does Asyam eat well? Is he a picky eater? The mineral levels are low and this can be largely corrected by diet. I know it isn't easy with kids but he needs to eat fruit and veggies and minimize the empty calories kids love so much. If it's a real problem getting him to eat well, a nutritionist may be able to give you some ideas. Thalassemia doesn't leave much room for error so diet becomes even more important than with non-thal kids. Celiac disease was mentioned and this can also deplete minerals and other nutrients. Has he shown any reaction to products containing wheat? Bloating, diarrhea or stomach discomfort? If this is any possibility it should be checked out.

None of his test results are so high that there should be concern of any immediate danger. They do show that there are some issues that need to be addressed, primarily his high ferritin and low minerals. The higher dose of Exjade should keep things level or possibly decreased and a higher dose should be eventually used as long as he tolerates it and his iron stays high. The nutritional problem also should be addressed. Is it his diet or a problem that is depleting nutrients? This must also be answered. Things can turn around with some work and at his age, it will prevent damage from happening as long as these problems are addressed. Ferritin over 3000 is high but at his age it is not the same as one who has had a ferritin over 3000 for 20 years or more. It needs to come down but it poses no immediate danger.

OK ANDY THANK YOU YES HE EATS EVERUTHING AND HE LOOKS VERY WELL
HIS FERRITIN IS ACTULLY 4000 I FOUND OUT TODAY SO NOT GOOD

Andy,

is the random glucose value of concern?  do these tests any kidney related problems?

Also Andy, a ferritin of 4000 for a two year old child only transfused 20 times?  A child who is chelating while many kids don't even chelate at that age?  What is causing the high ferritins?  has a ferriscan or squid been done?  These questions have been puzzling me all day which is why I did not know exactly how to respond. 
Sharmin

ANDY WHEN YOU SAY HIGH LIVER TEST HOW HIGH YOU MEEN SHARMIN  I REALLY AM SO SORRY I HAVE MADE YOU SO CONFUSSED ALL DAY BUT YOU COULD BE RIGH MY SON MAY HAVE SOME OTHER KIND OF PROBLEMS BECUSE HSI WHITE CELLS ARE ALWAYS HIGH ALWYS ABOVE 15 THEY GO TO 30 WICH IS TO HIGH

Mariam,

Don't worry Mariam,  your child's well being is worth the research and confusion.  I don't mean to indicate that your child's liver iron tests indicate that he is in any danger.  It is just that it would be unlikely that his ferritin would be that high from transfusions alone especially because he began chelation so early.  Perhaps there is another factor leading to the increasing ferritin, and perhaps you need to look into whether he has celiac or some digestive issue.  None of this indicates that your child is in immediate danger - your focus should be chelation and supplementing.  Could you please tell me his transfusion frequency and volume - if this is high then it would explain the high ferritin otherwise we are back to square one. 

Inflammation - can also give elevated ferritin levels as well as some of the other results that you are concerned about - and this may or may not be related to celiac (I am guessing). 

Don't worry, just try to get answers and tests from your doctor.  Can you get ferriscan or squid there?  that would help us greatly in determining if his iron is actually high or if the ferritin is elevated due to some other cause - the blood tx volume, frequency will also help.  BTW Mariam - this doesn't have to be urgent - just things to keep in mind when you visit the doctor. 

thanks Mariam,

Sharmin

HE GETS 220 ML BLOOD EVERY FOR WEEKS  WHAT IS  celiac HOW DO I DO THE TEST
I TOLD DOCTOR TODAY THAT I WANT A FRERRI SCAN DONE SHE SAID SHE WNATS TO GET LIVER BIOPSY

You can view the following sites for more info about celiac disease - but note this is just for your knowledge of what the disease is - I am not suggesting that Aysam necessarily has it. 

http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

http://www.celiac.org/cd-main.php

The transfusions you describe are NOT LIKELY to cause the ferritin levels that Aysam presents with.  That is why it thought that 2 scenarios are possible - 1. the high ferritin reflects some inflammatory condition rather than tranfusion related overload  2. something else, besides the transfusions, is causing iron overload in the body. 

the liver biopsy or ferriscan will give us this information - whether ferritin correlates with actual liver iron concentration.  My son has had to liver biopsies and he did well.  However, you need to be sure that they are being performed at an experienced center.

testing for things like celiac can also give us information - modifying his diet can alleviate this - as with celiac children often don't tolerate foods containing gluten or wheat.

I hope this helps a little Mariam,

Sharmin

Ferriscan and MRI are very unlikely to be used at his age because it is not easy to get a child to lie still long enough to do the scan. The ferritin does seem to be too high to explain as caused by transfusion alone. If there has been some infection it could explain a lot. If he eats a lot of iron foods it may also contribute, since his Hb has been allowed to drop fairly low before transfusions. I would also like to know if there is any sign that hemolysis is taking place which would lead to low Hb. Do you have results for reticulyte count? I think if celiac was present, he wouldn't enjoy eating and would have complaints afterward. If his stomach doesn't bloat and he doesn't complain of pain after having breads or cereals, celiac isn't likely. Does he ever complain after eating?

sharmin yes they told me about this when he had the test of his bowls blood in them but they also said they were normal he hasnt got celic

that's good to know.  i do wonder why he bloats so much - was that related to his chelation perhaps? 

ANDY NO
he never complains after eating and eats almost everything and anything good in his eating and rinks plenty of jusices apple orange and water so no problem there ANDY can you eplaine one thing fron the day he was born he has had high white cells always above 18 reachase sometimes 30 why ? what could this be  once they said they toght he had cancer but one doc said he thinks aysam is just like his his white cells arealwys high

you know i think it is related to exjade or desfral i think thats the bloating is ot a concern as much as teh feritin is 4000 for his age his weght is more a concern and he liver im more worried about dont u agree

Mariam,

Absolutely, his ferritin levels and liver function are most important.  I was just trying to determine if there is an alternate explanation for his elevated ferritin (such as inflammation) - other than transfusions.  But as Andy said, since his hg was allowed to go quite low between transfusions perhaps he has absorbed more iron through the gut then he would if his pre transfusion hemoglobin was kept between 90 - 100. 

I would stick with water or milk for drinks - juice can cause elevations in glucose levels, which in turn lead to an increase in insulin levels to deal with the high glucose - which can lead to a tolerance to insulin - resulting in diabetes.  Some juice is okay - just not a lot 

Sharmin