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What Does This Peripheral Smear Report Indicate?

Posted on Wed, 12 Oct 2016

Question: Hi my kid get bruises easily even for small physical injury. I have done pheripheral smear before 4 months and the report said she is having reactive lymphocytosis 6% and no blasts found. Now she still gets bruised easily. What should I do next? Do some more tests so that I can confirm she does not have leaukimia?

Answered by Dr. Diptanshu Das (2 hours later)

Brief Answer:
Please upload the reports.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone through the query and understand your concerns. I would insist you to upload the entire report. The details need to be correlated. A detailed clinical evaluation would still be needed and I would insist you to visit a doctor for the same. He would be able to rule out important causes like scurvy (which occurs due to Vitamin C deficiency), mixed connective tissue disorder or coagulation disorders as possible causes.

I do not think that it is due to leukemia. I can assure you after checking the report for the blood smear.

I will await your response.

Regards

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

Follow up: Dr. Diptanshu Das (46 hours later)

Dear Sir,

I have uploaded the reports. The tests were done in May when she got multiple small coin like bruises in her leg during football games.

Again she has small bruises when she got involved in physical activity. She got bruises once a month.

I have attached the photos of her recent bruises because of getting hurt by basketball on her thumb.

Please advice me the way forward or should I repeat the blood tests.

Thanks

Answered by Dr. Diptanshu Das (14 hours later)

Brief Answer:
Other causes need to be excluded.

Detailed Answer:
Thanks for writing back.I have gone through the attached reports and they are normal the tests not need to be repeated. Ruling out deficiency of haemostatic factors (e.g. von Willebrand’s disease and the haemophilias) would be the next step. Please go through:
http://adc.bmj.com/content/84/6/488.full.pdf

This journal articles summarises the probabilities beautifully. A methodical approach needs to be taken. Discuss with you treating physician accordingly.

Feel free to write back.

Regards

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

Follow up: Dr. Diptanshu Das (20 hours later)

Thanks.

I understand we have to go for genetic counselling if we need to find out the problem.

I have few more questions
1) she has a normal clotting for external bleeding. She had her tooth removed before 4 months and she had clotting with half an hour. Also her clotting time is normal in the reports. Only she gets bruises on any physical injury or activity.

2) if it can a genetic disorder how come she never had these symptoms before. Only now she has these issues.

3) none of our immediate relatives have this problem? Then is there a possibility she can have this issue?

4) if I give her healthy diet with proteins and increase her muscle mass , can this issue be resolved??

Awaiting for your reply sir.

Answered by Dr. Diptanshu Das (55 minutes later)

Brief Answer:
Connective tissue disorders need to be ruled out.

Detailed Answer:
Thanks for writing back once again. I would insist you not to grow apprehensive. Had it been due to clotting disorders probably it would have shown up in the tests already done. Rather, I am looking to exclude the possibility of mixed connective tissue disorders or vitamin C deficiency. Since the intervention would be specific to the cause, random efforts would not help.

A healthy diet is definitely needed for overall vigour but unless the specific issue is identified, it is unlikely to provide definite benefits. Genetic counselling is also related to the specifics of the finidings.

Feel free to write back in case of further queries.

Regards

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Diptanshu Das (26 hours later)

Thanks.
We checked and found that she has hyper mobility and her Beighton score is 8/9. Her other symptoms which she faces are 1) bruising 2) abdominal pain 3) muscle pain after a physical activity.

The doctor asked me to check for Elhers Danglos Syndrome.

I have a question here. She might also have hyper mobility without any syndrome. Can this be possible or is it connected with any disorders . She has a good intellectual, good dancer, height is 127 cm and weight is 26 kg. Should we be more concerned at this stage regarding genetics or it will be fine if we wait to see any other symptoms occurs.

Also if it keep her fit with minimal exercises and diet can she live normally without any problems.

Answered by Dr. Diptanshu Das (4 hours later)

Brief Answer:
Proceeding in right direction.

Detailed Answer:
This is exactly what I had been apprehensive about. I find a direct correlation with the easy bruisability. Management is supportive and would consist of measures to limit the problems she has. Otherwise you need not worry.

Regards

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

Follow up: Dr. Diptanshu Das (1 hour later)

Thank you. We will proceed with further investigation only if necessary.

Her bruise is healing better by 6 days and I feel she will be alright soon. She has minor complications with health and it is manageable now. I want her to have a happy childhood.

Answered by Dr. Diptanshu Das (3 hours later)

Brief Answer:
Feel free to ask me back in case of further queries

Detailed Answer:
The easy bruisability problem is a minor one and is unlikely to lead to serious complications. Any other complications would need to be managed as they arise.

Feel free to write back if you ever have any other query and I would be glad to help.

Regards

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

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