Brief Answer:
Unusual WBC counts and their inference

Detailed Answer:
Welcome to Health Care Magic.

Thanks for writing.

I am Dr. Saddiq ul Abidin. I have read your question completely, I understand your concern and will try to help you in best way possible.

However, here, It would have been if we had known whether he has any history of fever or any associated illness for which you have done these tests?

Secondly, WBC of 23 is quite high and often occurs in acute infections. But for that, 1.9 Neutrophils is not comparable, as normally Neutrophils have to be 50-80% of total WBCs.

Their depletion upto this level, will either means, that some other cell lines are predominantly raised, like lymphocytes; which are raised in viral or chronic infections, or eosinophills; which are raised in allergic or parasitic conditions.

You need to reconfirm the report or if it is really so, than try getting a peripheral smear for atypical white blood cell species present in the blood to be detected under microscope. Also visit a pediatrician near your location, and get a thorough check up done if their is any associated illness or symptoms which are unusual than normal.

In any case, clear any discrepancy from the report or get further investigations and work up done, after careful examination of the child by a pediatrician.

I hope this answered your question. If you have more queries I am happy to answer. Otherwise rate before closing the discussion.

You can also contact me directly through: http://doctor.healthcaremagic.com/doctors/dr-saddiq-ulabidin/70164

Regrads.

Dr. Saddiq ul Abidin

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Brief Answer:
Recurrence of attacks and use of antibiotics with some clarifications

Detailed Answer:
Thanks for putting every single thing quite convincingly, to know the situation little better.

There are three things i would like to clarify based on my understanding, regarding your issues. You can correct me further, whether i got your queries right or not?

Basically it is quite possible to get a tonsillitis with out a fever, but with other associated symptoms relating to the throat, and can be picked up on general physical examination upfront.

The raised WBC count, Upto such high extent,is though explainable, with such symptoms, but at the same time the discrepancy in the report, i was mentioning earlier is still there, as such differential counts with so low neutrophils, means that the high WBC is at the expense of other cell lines, like lymphocytes or eosinophils, so a better approach would be to reassure the report, or repeat it after the course of antibiotics.

Also as far as recurrences are concerned, tonsillitis is one of those, which is notoriously known, for its recurrences in some individuals and that is why surgical options have been devised. I would suggest you, that with such frequencies of the attacks, you need to consult an ENT specialist to get evaluation for the reason of such recurrent attacks.

Meanwhile you can continue using second course of antibiotic, as leaving them in between would trigger resistance towards such antibiotic for the future use. Also in my clinic, i suggest throat and blood cultures before repeating antibiotics, to determine the exact notorious bug, and to aim the treatment based on the sensitivity spectrum for the organism later.

Thank you for sharing your concerns, Kindly rate me before closing the discussion. For further Queries, You can approach me with my name or profile link directly, whenever you want on this link.
http://doctor.healthcaremagic.com/doctors/dr-saddiq-ulabidin/70164

Keep me apprised. Good day.

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Brief Answer:
clarification of certain doubts

Detailed Answer:
Thanks for sharing the details.

Well, your concerns are quite right, and presence of lymph nodes with such high WBC count, can raise few eye brows regarding the things you have mentioned, but it is really too early to comment about that conclusively.

As every headache isn't a brain tumor, similarly as long as the WBC is responding to antibiotics, scenario is hopeful.

Also that lymph node can be explained with tonsillitis and since on examination, it is quite evident so that may be a reason paediatric an kept him on monitoring yet.

The best approach would be to repeat, complete blood picture once antibiotic course is complete and hope for WBC count to come down and lymph nodes to settle or decrease in size.

On the next CBC, the scenario will be much clarified, as what and how to proceed.

Try sharing the lymphocytes count, among whole WBCs, as lymphoma is tumor of lymphocytes, so on extra nodal cases it is often very high.

The next likely step can also be lymph node biopsy, whether excision one or with a needle as is called FNAC. That will be suggestive that whether is there any likelihood of severe possibility? Biopsy can even tell, if lymphoma is present or not, and whether there is any possiblity of other long standing infections like tuberculosis? It can even tell type of lymphocytes predominantly present?

If WBCs remain high, multiple other tests may also be needed as LDH, ESR, Calcium, phosphate, and other biochemical tests.

I hope it has clarified many doubts in your mind. Kindly do rate me before closing the discussion. Hoping that everything comes out to be normal for him. Keep me apprised. Regards, Good day.

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