What Does The Blood Test Report Indicate?

Posted on Tue, 1 Dec 2015

Question: Hello Doctor,
My wife (35 years) has fever from past 5 days (today is 6th day). Fever initially was 1-2 times a day but for last 2 days it is persistent (3-4 times a day). The fever only comes down with Meftal Forte tablet. Paracetamol is not helping. We did test and getting below readings which are beyond the normal readings:

Erythrocyte (RBC) Count = 4.02 (vs. range of 4.2 to 5.4)
MCH (Mean Corpuscular Hb) = 31.37 (Vs. 27-31)
Platelets :
PCT (Platelet Haematocrit) = 0.16 (Vs. 0.2 to 0.5).
ESR - Erythrocyte Sedimentation Rate = 28 (Vs. 0 - 28)

One of our doctor is suggesting hospitalization as fever is persistent for 6 days. (Goes uptp 101.5 F)

1. Could you please advise the same or some other medicine?
2. She is currently taking Milixim 200 as antibiotics however, it appears to be giving pretty severe mouth ulcer. She has taken it for 3 days. Can we discontinue its use?

Thanks in advance,
xxxxxx.

Answered by Dr. Anshul Varshney (12 minutes later)

Brief Answer:
Requires evaluation.

Detailed Answer:
Welcome To HCM. I am Dr Anshul Varshney. I understand your concern.
Yes definitely fever of such grade for 6 days require evaluation for common causes like Typhoid, Urinary tract infection, Malaria.
There is no indication of admission according to the symptoms you are describing.
You can simply get her investigated on OPD basis.
I would recommend following tests:
1. Typhi DOT.
2. Urine examination.
3. Repeat complete blood count.
4. Malaria antigen.
You can give her Paracetamol 650 mg every six hourly for fever.
Since she has atleast taken Milixim for 3 days it might not be further effective.
For oral ulcers she can take a Zinc containing B complex like Becosule-Z.
I would say that she should be evaluated properly before any further antibiotic is given.
I hope it helps you.
If you have any further query, please ask me.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Anshul Varshney (40 minutes later)

Hello Dr. XXXXXXX

Thanks indeed for your prompt help. Relieved to know that no immediate admission is required.

So far, we have done : CBC, ESR, Urine R, PS and Widal test. I have I have just uploaded the available reports. Kindly go through the same. I will get Widal Test report tomorrow. I will share it at once and will also do the Typhoid, CBC, Malaria tests as per your recommendation.

Just to be sure, we can stop using Milixim... right?

I also suppose (hope), Dengue is ruled out... right?

Thank you so much again,
xxxxxx.

Answered by Dr. Anshul Varshney (21 minutes later)

Brief Answer:
Needs proper clinical examination.

Detailed Answer:
In the attached reports malaria test is also negative.
Dengue test has not been performed so it would be difficult to comment as platelets may be normal in the initial days of fever.
Widal test comes positive only after a week of fever so there is no point in getting it done so early.
So tomorrow would be her 7th day of fever and so widal test and Typhi Dot IgM should be performed.
This could be simply a viral fever as these days viral fever takes long for the recovery.
My recommendation would be a proper through clinical examination including tonsils and lymph nodes by your doctor.
Do get widal, typhi dot and repeat complete blood count tomorrow.
I wish her a speedy recovery.
If you have any further query, please ask me.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Anshul Varshney (34 hours later)

Dear Doctor,
I have attached CBC report on 12-Nov, 13-Nov for comparison and Typhidot IgM. Kindly check.

Summary:
1. Typhidot IgM : Observed Value: Positive. Biological reference interval = Negative.
2. CBC Comparison:
Erythrocyte (RBC) Count 12-Nov:4.02 13-Nov:3.83
Haemoglobin (Hb) 12-Nov:12.6 13-Nov: 12.18
PCV (Packed Cell Volume) 12-Nov:37.18 13-Nov: 35.37
MCH (Mean Corpuscular Hb) 12-Nov:31.37 13-Nov:31.8
PCT ( Platelet Haematocrit) 12-Nov:0.16 13-Nov:0.17

Widal Test for Typhoid results are pending. Will report at once available.

Fever still keeps coming back and goes down only after taking Meftal Forte tab.

Thanks indeed doctor,
xxxxxxx.

Answered by Dr. Anshul Varshney (1 hour later)

Brief Answer:
Typhoid fever

Detailed Answer:
Hello, So the diagnosis is typhoid fever as the Typhi Dot IgM is positive. Widal test may or may not be positive at this state.
So, see your doctor, show him the reports and he would start her on treatment for typhoid fever. She would soon get better.
If you have any further query,please ask me.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar