Annual check up

Hi

Today and tomorrow i am doing the annual check up for my son. The results for the liver and kidney functions in addition to the thyroid gland came all normal. Also the serum calcium, zinc are normal. His ferritin is 62. I also did a random blood glucose and came back normal.

On Tuesday i will recieve the report for the abdominal and pelvic ultra sound and the report for the echo

I have some questions:

1- Serum phosphrous is   6.4mg/dl  the range is  (2.5 - 5 ), so being more than the normal, can cause any problem???

2- His serum uric acid is 6.6 mg/dl and the range is (3.4 - 7.2 ) so should i  consider him high normal  ?

3- One important thing, i really need to know an answer for... usually hematocrit is directly propotional with the hb. I find in my son's CBC a differnt result this month.

Usually when his Hb in the range of 6 to 6.5, the hematocrit is 16% to 17%. Last month his HB was 7.1 and the hematocrit rised to 18.6% and MCV was 53.

Today and after one month (by the way he had a viral infection in the mid of January but with no fever at all..all symptoms where severe back charge that made him cough for a couple of days), his Hb is 6.1 and the hematocrit increased to 19.3% and the MCV increased to 55. Isn't that strange, shouldn't they both go down with the HB!!!!!!!!!!!!!!!!!!!

Andy do you think that a decrease of one gram could only be due to the viral infection though without fever or this could suggest increased activity of the spleen?? Please advice

On Wednesday, i will visit both the hematologist and the endocrinologist after receivng the other reports.

manal

Manal,

I am glad that his results have come back good so far.  I hope that the rest of the tests will be good too.  I hope that his hg rises again soon.

Sharmin

Thanks Sharmin

I forgot to mention that i will too visit the dentist to check if there is any change in the jaws indicating any deformity.

I hope i didn't forget anything else

Andy

I  asked about the medullary width (MW) in the midpoint of the second left metacarpal measurement but unfortunatly it is not available here
http://www.ncbi.nlm.nih.gov/pubmed/3426965?dopt=Abstract

manal

Manal,

Good luck for your visit to hemotologist,endocrinologist and dentist,i am happy his results are normal,minor drop in hb can be due to infection,so don't worry  .

Zaini.

Manal,

I hope that the rest of your appointments go well.  Are the results similar to those in previous years? 


Sharmin

Manal
GoodLuck with the remaining tests. Usually when phosphorus levels rises, calcium is lost via the urine, but as his calcium is ok so there`s nothing to worry about. Hassan`s hematocrit changes with his hb, higher the hb higher the hematocrit, but cannot say the same for his mcv. There was a time when his hb was very low but his mcv was near to normal.
take care
maha

Hi Manal,

1) From http://lpi.oregonstate.edu/infocenter/minerals/phosphorus/

Is high phosphorus intake detrimental to bone health?

Some investigators are concerned about the increasing amounts of phosphates in the diet which can be attributed to phosphoric acid in soft drinks and phosphate additives in a number of commercially prepared foods (5, 6). Because phosphorus is not as tightly regulated by the body as calcium, serum phosphate levels can rise slightly with a high phosphorus diet, especially after meals. High phosphate levels in the blood reduce the formation of the active form of vitamin D (calcitriol) in the kidneys, reduce blood calcium, and lead to increased PTH release by the parathyroid glands. However, high serum phosphorus levels also lead to decreased urinary calcium excretion (2). If sustained, elevated PTH levels could have an adverse effect on bone mineral content, but this effect has only been observed in humans on diets that were high in phosphorus and low in calcium. Moreover, similarly elevated PTH levels have been reported in diets that were low in calcium without being high in phosphorus (7). Recently, a controlled trial in young women found no adverse effects of a phosphorus-rich diet (3,000 mg/day) on bone-related hormones and biochemical markers of bone resorption when dietary calcium intakes were maintained at almost 2,000 mg/day (8). At present, there is no convincing evidence that the dietary phosphorus levels experienced in the U.S. adversely affect bone mineral density. However, the substitution of phosphate-containing soft drinks and snack foods for milk and other calcium rich foods does represent a serious risk to bone health (see Calcium).

As long as his calcium intake is good, the phosphorus level isn't of concern but caution is advised concerning soft drinks containing phosphates.

2) Uric acid levels can also be related to diet. Purine-rich diet — organ meat, game meat, anchovies, herring, gravy, dried beans, dried peas and other foods. Test results also vary from lab to lab. High end of normal isn't significant.

3) I do think the virus could be responsible for the lowered Hb. The MCV value is not much different and would have to be considered as no real change. Hematocrit measurement is  affected by various factors. http://www.daviddarling.info/encyclopedia/H/hematocrit.html

A true baseline Hct value may be hard to measure accurately for a variety of reasons. For example, when drawing a blood sample from a subject, a stress response may cause a contraction of the spleen, resulting in a momentary increase in Hct. Hct may also vary dramatically with physical activity.

The accuracy of all these tests varies from lab to lab and even from lab tech to lab tech, so small changes are often meaningless.

Sharmin

I started doing these check ups since 2006 and usually they are the same except for the zinc that usually was defient but since then i check it every 3months in particular and make sure it is always in the normal range.

Maha
Thanks a lot for your information and wishes

Andy
Thanks a lot for the informative reply . Ahmad never drinks any soft drinks but i think i will have to check the phosphrous again in three months, do you agree.

As for the uric acid, you are right .The week before the CBC he ate fish a lot and i believe they are rich in urates.

manal

Manal

It has to be a viral infection which has brought Ahmad's hb dow. I have faced this with Prat all the time and hb sometimes have fallen by 2.5 grms.

Take care

Puja

Thanks Puja for reassuring me . Today i will update you with the other reports

manal

Hi

1-The Echo report came totally normal for his age and the cardio even told me that his heart is not beating that fast compared to his low Hb ( One information i knew today from the cardiologist is that, when a child has a fever, every increase in temperature by one grade increases the heart pulse 10 more beats)

2- Also the ultra sound report came normal for everything except for the typical increase of liver and spleen off course. The long axis of the spleen is 12.7 cm which is twice the normal size. Both organs are well except for the enlargement.

The GOOD NEWS is that Ahamd used to have a gravel in the gall bladder (1-2mm), but the report came that he is now totally free of any stones in the gall bladder . The doctor made a long scan to try to find it but it has just disappeared. I never imagined that this could happen,but the hematologist said that these small gravels sometimes break to small pieces and are released out.

Andy, do you think taking magnesium for more than 8 months now has contributed to this??

3- Usually Ahmad's total Bilirubin is 1.7 or 1.8 when his HB is in the 6 to 6.6 range. I have noticed that two or three months ago, the bilirubin started to increase to 2 and to 2.5. Even last month when his HB was 7.1, it didn't go down and it was also 2. This month it is 2.4 , so does this indicate over activity of the spleen and if this is the case, the HB should have decreased but it is nearly the normal Hb for him but only the bilirubin increased??

The doctor told me it may be both the spleen and also the viral infection that caused this drop in HB. She usually measures the enlargement of the spleen by a measuring tape. In the past two years the minimum and the maximum measurement for the spleen were 3cm to 5cm more than the normal size. Today and for the first time, she measured it and it was 6cm

At the end, we agreed on starting the hydrea again, so starting today Ahmad is on the hydrea again (20mg/kilo). I really hate gving him the chemo, but there is no other way as i am afraid he could get worse.

She also changed the dose of folic acid (for one month) to 5mg a day and 10 mg the other day ( i mean alternating days)

As for the growth, he is okay and he is still in the 25th percentile for weight and height

I will update you again

manal

Hi Manal,

When I read about the gallstone vanishing, the first thing I thought of was magnesium. People who test higher in magnesium have fewer gallstones. Our group probably has the first people testing this in thals but I do think blood cell health and the health of the spleen and gallbladder can be enhanced with magnesium supplements.

Has Ahamd's reticulocyte been up also? If it is, it could explain the higher bilirubin level.

Hopefully, the hydroxyurea will help shrink his spleen in addition to raising his Hb.

Thanks Andy for your reply.

Yes Ahamd's reticulocyte count is getting higher every month.Last month, it was 6.4% but this month it is 7.8%

manal

Manal,

I am glad that Ahmad's gall bladder stone is gone.  I hope that his spleen shrinks with the hyroxyurea and that you see an an increase in his hg.  I am glad that his echo report came back normal and that he is growing well.  You are doing a wonderful job with him Manal. 

It seems that all of our young ones are having their tests done within these few days - I hope that all of the reports come back as being encouraging and that appropriate plans will be given to us so that future reports are even better. 

I hope to come back with information that is helpful to everyone here.  I hope that I have enough time to have a good discussion and answers to everyone's questions. 

Best,

Sharmin

Manal,

It's very good to know that Ahmed's echo came back normal, i hope his bilirubin will go down soon,Good luck with hydrea  i hope it will increase his hb this time.Manal,what about that other treatment you were giving to him?

Zaini.