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Hi, I Have 2 Years Old Son. Recently We Noticed
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Although AST ALT in range but AST is touching upper border and APT being lower than AST, is it ok, because yellowness is there in body. Not only palm and feets but I can see body also kind of pale or yellow, therefore I was worried about this ratio reversal. Such ratio is reported every where associated liver serious diseases. How comforting are these reports with respect to that. And WBC being low is another worry for me, because it's being reported with serious disease like home marrow suppression, leukemia etc. Is neutropenia normal without these serious diseases too, like with viral fever or something. Because there are no sign of viral infection of any type. His breathe is giving kind of fruity smell , I have observed even after brushing, and when exhaling too. Can this be related. What test would you suggest ? And what possible causes for yellowish discoloration as per your opinion. He is fit and fine otherwise, no other symptoms appears to us, so this sudden rapid kind of discoloration we observed in last 6 days made me worried, and his low WBC also, whether he is prone to infection with such low neutrophils. As in his case his numbers are in severe neutropenia, which again is reported with serious diseases. Sorry for asking again, but please give detailed reply. Thanks and Regards.
he has been vaccinated for Hep A and Hep B. I did not find any viral symptoms in him so far, totally healthy. Skin color is normal when not seen relative but obvious looks yellow when looked . I am mainly concerned about leukemia or any other liver related serious issue. His pictures are appearing extra yellow but doesnot look yellow that much in day time.
Needs urgent evaluation, further tests
Detailed Answer:
Hi
Thanks for writing to us.
I have seen the attached reports.
1. Definitely he looks jaundiced. No doubt. Crystal clear in pictures.
2. Last blood test was 4 days ago. I am sure now Ot would be worse than before ( ast all bilirubin all would have changed now)
3. Definitely he has HEPATITIS with JAUNDICE.
4. High AST ALT ratio could go with liver damage. But in most infective hepatitis it is usually ALT more than AST and they will be in thousands ( recheck tomorrow morning am sure it will be be more abnormal)
5. Take him to a Multispeciality hospital preferably children superspeciality like gastro or liver department.
6. Low wbc indicates probably viral infection, it could be still rare causes like infiltrative diseases like you mentioned. Again detailed workup is required before he deteriorates clinically.
7. Common causes of liver damage at this age are infections, paracetamol, native drugs.
8. ENTIRE WBC and differential count is low, this could indicate immune suppression and risk of secondary infections.
9. To SUMUP - PLEASE GET HIM EVALUATED WITHOUT DELAY. REPEAT LFT, CBC, VIRAL MARKERS FOR A, B ( even if vaccinated you can still get infection), coagulation profile, electrolyte, renal parameters, ultrasound abdomen.
Wishing your child good health and speedy recovery
Dr XXXXXXX
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Continue evaluation and see a specialist soon. DON'T TAKE CHANCE
Detailed Answer:
Hi
It still could be infectious or causes like you mentioned. Further tests and evaluation by a specialist is mandatory.
Most of the hospitals are open. Consult specialist without delay.
You mentioned rise in urea which is not a good sign. This could indicate hepatorenal involvement.
Regards Dr XXXXXXX
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Gastroenterologist or liver specialist
Detailed Answer:
You can try pediatric gastroenterologist or liver specialist. If not available at least any liver specialist or gastroenterologist can do the necessary evaluation and management
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Rising urea as you mentioned
Detailed Answer:
You had mentioned rise in urea.
This can be due to various causes like dehydration and sometimes hepatorenal.
In patients with liver issues, there can be decrease in kidney perfusion resulting in this condition. It can be very mild, temporary, resolve on its own with liver improvement.
But needs a close watch and regular monitoring of urine output, blood urea and creatinine levels.
Any rise in creatinine in further tests will confirm if it is indeed hepatorenal or not.
Regards
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