Discussions By Condition: I cannot get a diagnosis.

White blood cells?

Posted In: I cannot get a diagnosis. 22 Replies
  • Posted By: tnmomma
  • January 6, 2009
  • 01:24 AM

I posted a thread a few days ago about my son's condition. We have received his test results for the neutrophil oxidative burst test. The results took 3 weeks to come back when they were supposed to have taken one. When they returned, it said that my son had 0 granulocytes and the test needed to be redone. Are they redoing it to make sure he really has none? Did they mess up the blood sample? If they had messed it up, wouldn't they have just said they couldn't test his blood? A normal range of granulocytes in a person's body is >76%. Is it possible for someone to have none?

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22 Replies:

  • A lack of sufficient neutrophils would be termed agranulocytosis and does occur under certain conditions. We would need to see the most recent lab studies to determine whether such a fall-off would be probable. I think at this point, they need to perform another test. Granulocytes can be reduced by inability of formation in the bone marrow or contrastly, be lysed or destroyed at a rate higher than production. Keep us posted and we'll do what we can to discuss the results with you. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 6, 2009
    • 02:02 AM
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  • Thank you for the response. The lab report was very brief and just said that the normal range was >76% and my son's was 0.0 L. It said something to the effect that there weren't enough granulocytes in the sample. The report said the test needed to be redone, which I'm going to schedule tommorrow. Do you think it's a bad sign that it took 2 weeks longer than it was supposed to to get the results back? I am just having a hard time reasoning that there were absolutely none unless something really is wrong. If he did have a normal amount and for some reason the test was skewed, wouldn't there still be a small percentage at least? I mean, if most people have 76% or greater, what are the odds my son would have none, and it's a mistake? I don't think I can take another 3-4 weeks stressing over this while in the mean time my son keeps having his staph infection come back again and again! I just need something, whether it's good or bad. He has been having these staph infections for 7 months!
    tnmomma 13 Replies
    • January 6, 2009
    • 05:09 AM
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  • If he continues to have Staph.infections,you'll just have to hope that they put him on the right antibiotics.Neutrophils fight off bacteria,so if his are low,he'd be prone to such infections.No,I've never seen an absolute count of zero,so let's be hopeful.
    richard wayne2b 1232 Replies
    • January 6, 2009
    • 00:58 PM
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  • Currently they are treating his staph infection with clyndamiacin, but his hand just broke out again and for the first time ever, I was able to get the medicine on the day of the first blister without having to go through cultures, etc. Anyway, his hand is still barely progressing, but not completely healing. Usually his hand looks like it will fall off by the time I get the medicine, and the medicine clears it up. This time, it's not progressing NEARLY as fast, but still is a little bit, so I don't know if the med is losing it's effect or what. On the report:Okay, my mom brought over the report just now (I had it faxed to her house.) This is what is says: In Range Out of range Units Reference RangeNeutrophil Oxidative Burst Test 0.0 (L) % "Unable to report result for % Oxidizing neutrophil as the sample did not have granulocytes present. Request new sample be submitted." So, not a lot to go on, but would love more feedback. Ugh, I tried to edit the format to show how it is on the paper. The in range, under it was blank. The out of range was supposed to be over the 0.0, Units was supposed to be over the %, and the ref range was supposed to be over the 76. Sorry for the jumble.
    tnmomma 13 Replies
    • January 6, 2009
    • 04:33 PM
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  • It surely seems that there are no granulocytes present,which,as you know,is a big deal.I had hoped I was wrong.
    richard wayne2b 1232 Replies
    • January 6, 2009
    • 07:56 PM
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  • Is there anything though, that would cause that to be a mistake? Also, can you share your knowledge about conditions w/o gran.? online reading sometimes doesn't give the clearest picture.
    tnmomma 13 Replies
    • January 6, 2009
    • 09:23 PM
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  • Surely,mistakes are possible,but not being a clinical pathologist,I can't be more precise than that.
    richard wayne2b 1232 Replies
    • January 6, 2009
    • 10:51 PM
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  • I'm going to suggest here that you discuss hospitalization with your primary care physician or specialist at this point. Realize that if your son is truly agranulocytic, then certain opportunistic infections can arise with the ability to seriously challenge his present status. While working to obtain retesting, I'd also have your physician consult with hematology and discuss whether a bone marrow aspiration would be advisable for a more clear indication of whether granulocytes are either not being produced or alternatively are being lysed within the bloodstream. Either way, the staff infection you are presently addressing could indeed get out of hand and the chances of being exposed to an MRSA type of infection is a likelihood since we have a test that has a chance of being accurate. It's not an instance where he could necessarily need hospitalization, but immediate planning should be underway to confirm or refute what the test results are suggesting and I would not advise waiting another 2 or 3 weeks before taking interim measures. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 7, 2009
    • 00:06 AM
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  • The ID doctor he is seeing hasn't even spoken with us. He had the nurse call me with the results and she is supposed to call me back about redoing the bloodwork. She said she would speak with the dr. and see if he even wanted to see us or send us straight to the lab. That's what is confusing me because they are not treating it as if it's serious. How would you suggest the best way to approach the doctor about this? Either, he has no idea what he's dealing with, or I dunno?!? You would think they would be alarmed with the results, and I don't even have anyone to discuss the results with other than this forum!!!
    tnmomma 13 Replies
    • January 7, 2009
    • 00:28 AM
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  • I need to clarify that all through my son's sickness, it has been like pulling teeth to get doctors to try to figure out what's wrong with him. I really am at a loss as to where to turn now. If the ID dr. isn't gonna take this seriously, I know his pediatrician won't. The only dr that has been of any help was the ped derm at Vanderbilt. Should I call his office tommorrow and talk to him about this???
    tnmomma 13 Replies
    • January 7, 2009
    • 00:42 AM
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  • Okay, you are unrestricted to immediate access for purposes of direct evaluation to determine the nature of the test results and I would strongly urge you to simply bypass the physician in question and contact a pediatric hematologist directly. I would suggest that you tell them that your son is experiencing a staff infection that appears somewhat resistant to treatment and that the lab test indicated agranulocytosis with 0.00 count. Ask for an immediate appointment to begin thorough and continuous evaluation until you and the hematologist are both certain that the situation is under control and steps are being taken to remedy the problem. This you must undertake with a good degree of authority and persistence and do not relent until your son's health issues are the foremost task being directly addressed until the cause is identified. I would awake in the morning with a clear mission in mind and push until the situation yields the desired result. A good starting point would be Vanderbuilt. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 7, 2009
    • 00:49 AM
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  • I really sense your distress and wish I could provide you with more comfort.Yes,you would think that the gravity of this problem would at least arouse someone's attention enough to respond to you.I'm really sorry that you're having to endure this.
    richard wayne2b 1232 Replies
    • January 7, 2009
    • 01:00 AM
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  • Thank you for the fast result. I was hoping you would reply back. I have been hitting refresh :) I am on hold with the answering service at Vanderbilt, as this seems to be the fastest way of communication with anyone to call me back. I know the resident dermatologist will not be able to do anything tonight, but I feel confident I will get a call back immediately tommorrow from someone that can get me help somewhere. Vanderbilt is 5-6 hours away, and an hour time difference, and there is always such a lag. I am going to say to them specifically what you have said to me. See, this has been ongoing for 7 months. If you look for my other post, it's help with my 2 yr old, it goes more in depth. I have had a greatly difficult time dealing with people and have been pushing since day one like the crazy lady!!! I will update you and thank you so much for the help.
    tnmomma 13 Replies
    • January 7, 2009
    • 01:00 AM
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  • I really sense your distress and wish I could provide you with more comfort.Yes,you would think that the gravity of this problem would at least arouse someone's attention enough to respond to you.I'm really sorry that you're having to endure this.Thank you so much for your responses as well. Gosh, it feels good to have someone to listen and give some advice. You don't even know. I have been like a blind person feeling my way around trying to get my son some help. I just have a bad feeling about his hand, as he woke up in the middle of the night last night and was extremely tossing and turning. His hand is not getting better with this round either. I do feel like he would have priority in a hospital if he were admitted, it is just getting him admitted that will be the hard part. Thank you again for your support and quick responses also.
    tnmomma 13 Replies
    • January 7, 2009
    • 01:02 AM
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  • Okay, so I spoke with the resident. She said I shouldn't "put much stock into the lab results until the repeat it.". LOL. She didn't really have much advice, which I didn't expect, but she is emailing the dermatologist that sees my son to see if they want him back down there to look at his hand and possibly get him on another antibiotic. She suggested about the lab test, to just have it repeated, even if it takes a while, and that she didn't think he needed to be in a hospital unless he had an uncontrollable fever over 102 or sever vomiting. Who knows. I am off to bang my head against the nearest wall.
    tnmomma 13 Replies
    • January 7, 2009
    • 01:21 AM
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  • You're very welcome although I don't know what I did to help.
    richard wayne2b 1232 Replies
    • January 7, 2009
    • 00:25 PM
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  • Okay, the problem here is seeking an answer to a possible systemic issue that a dermatology resident would have to likely seek out the nearest dictionary in order to spell, much less offer useful direction. Wrong approach. I would contact the hospital, seek out hematology directly and request the number to fax the lab report along with his symptoms so that a faculty member can offer you some direction or better yet, direct evaluation of your son. Do not accept advice from a nurse, PA or resident. Request a faculty member, preferably one with tenure. It's not that I question whether the test is valid at this point, but the case for whether your son possesses sufficient granulocytes to fight off infections that could place him in a very bad position in a short amount of time. I seriously doubt that the granulocytes are actually zero, but until confirmation through retesting is obtained, I would press for hematology to see him directly. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 8, 2009
    • 01:54 AM
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  • I wish it were as simple as that, but for whatever reason, you absolutely cannot get an appointment with a specialist at Vanderbilt scheduled for 2-3 months without going through someone else. I knew the derm couldn't do anything about the lab results, but this is my fastest route to get him into see a hemotologist. The dermatologist wouldn't even see my son for 2-3 months even though his condition was really bad, so I drove 6 hours and took him to the ER where they looked at me like I was crazy bc, obviously he showed no signs of an "emergency", but it did cause them to reschedule his appointment to be within 2 weeks of the ER visit instead of 2-3 months. That really, was my only reason to call derm, because the derm, even though he has admitted cannot help any further than he has, still is taking my son's case seriously, and I know will see him and get him into a hematology specialist a heck of a lot quicker than if I call to schedule him an appointment, regardless of whether they see his test results. Hope that makes sense. We have an appointment this morning with the ID dr, as I called yesterday after receiving no call to schedule his labs and insisted he have an appointment with the dr. instead of being sent straight to the lab so I can personally ask the doctor some questions. My son has for the last couple of weeks been complaining of wanting to "take his head off". He will pull on it and say he wants to take it off because it hurts. His eyes have also been hurting. Also yesterday, he really scared me because he was standing still and looked at me and said whoa mommy whoa mommy, I fall down. I don't know if he was dizzy, but he certainly was not playing. He has also been waking up in the middle of the night for the last few nights and last night he was really strange. He woke up and we went to get something to drink, and he said he couldn't see, several times. Not like, he couldn't see cuz his room was dark, it was just odd. Anyway, I will update after this appointment. I suspect I will not get any answers, but I can hope. Thanks for the advice, and I assure you, that I have been at this for months now, and have no prospects of giving up. I really didn't expect the on call derm resident to have any helpful advice, but can help me get into position for help higher up on the chain.
    tnmomma 13 Replies
    • January 8, 2009
    • 00:16 PM
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  • We are back from the ID dr. They are going to rerun the test on Monday, and he didn't really have much to say about it, except it could be a mistake. He put my son on zyvox, which we are waiting to be authorized through insurance, and a new ointment, I don't remember the name of. Have any of you ever heard of zyvox before?
    tnmomma 13 Replies
    • January 8, 2009
    • 05:59 PM
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  • Zyvox is an antibiotic that is very powerful.It should not be taken with SSRI's nor with things that contain tyramine.
    richard wayne2b 1232 Replies
    • January 8, 2009
    • 08:30 PM
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