High platelet count/CML question

I've got a small four year old. He weighs 28 pounds. Two years ago he
weighed 26.5 pounds. My doctor is very worried about this. He asked for
a CBC count. It came back with lowish iron: 11.3, normal white blood: 6.5
and high platelet count, 514 where 150-400 is normal.

I'm trying to put this in context and figure out what next to do with
him. I'd appreciate any perspective or insight. This has us all puzzled.

The child acts well, eats normally (sometimes he has an appetite,
sometimes he doesn't) and has normal energy levels. He doesn't get sick
easily (and hasn't had a cold yet this fall.) He has no trouble keeping
up with his active preschool class. He doesn't need naps.

But he's got two bizarre health problems: a year ago he nearly died from a
perforated intestine and the resulting peritonitis and we have never
figured out what caused the perforations (there were several small ones in
his upper intestine.) At that time he had an ileus for about two weeks
and lost quite a lot of weight - he has regained it all and doesn't appear
to be skeletal, he's just SMALL.

The other bizarre health problem is his teeth are shot. Just before he
turned four he suddenly presented with five cavities and an abscessed
tooth. We were never lax about his everyday dental care but in the past
four months (since this problem suddenly developed) we've been totally
anal about brushing and flossing and fluoride. And yet new cavities are
still showing up and now he's up to SEVEN cavities with two abscesses.
(Well, one abscessed tooth was pulled, but now there's a new one.)

No one in the family has anything like it in terms of bad teeth. As best
we can tell the two week period where he had the ileus (and consequently
lots of stomach acid in his mouth) must have damaged the enamel in his
teeth. He occasionally has tooth pain from this but in those cases we
feed him liquid food (protein shakes, yogurt, stuff like that). We are
continuing to address his dental issues aggressively.

Meanwhile, he's still small, but this is actually a common occurance in
our family. His siblings and most cousins were at the low end or below
the weight charts. My older kids always wore their age in clothing
sizes. In the context of his illness/weight loss, steady recovery and
sibling history his size doesn't concern me... but it obviously concerns
the doctor.

So... in this context, what do you suppose a high platelet count means?

His doctor said to finish the teeth thing (that'll take two or three more
months) and then we'll retest the platelet count. The doctor didn't
discuss with me the implication of a high platelet count but I
understand it might mean CML. (I asked him specifically about the
meaning of a high platelet count but he was actively trying NOT
to scare me and didn't want to get into scary cancer talk about one test.)

If it were CML wouldn't my son appear unwell? And doesn't the white blood
count get affected by that? Would it have anything to do with his size or
his bad teeth or peritonitis? (I just can't see it!)

What do you think?

Wendy

When I did a search for high platelet count, there was mention of Kawasaki's
disease and bacterial infection someplace in the body, like pneumonia. If
you would like to see the web site I went to it is
http://www.sma.org.sg/smj/3911/articles/3911a2.html

Another site that had good information and one that describes much of what
you describe is
http://www.ehendrick.org/healthy/001352.htm

The technical name for high platelet count is thrombocytosis. So you can do
more research if you like.

I would be more worried about the low iron and would probably start giving
either higher iron foods or iron vitamins. In my reading, it seems the high
platelet count could be attributed to low hemoglobin.

We have the opposite problem as you, my daughter has extremely low platelet
count and is very anemic. Good luck, I hope you find a cause. But, mostly it
looks like unless there are other problems occuring, the high platelet count
is not one to be very worried about. Remember too that anemia can result in
a low appeitite and perhaps that is why he is small. Is he tall?
--
Sue (mom to three girls)
I'm Just a Raggedy Ann in a Barbie Doll World...

Wendy wrote in message
...
I've got a small four year old. He weighs 28 pounds. Two years ago he
weighed 26.5 pounds. My doctor is very worried about this. He asked for
a CBC count. It came back with lowish iron: 11.3, normal white blood: 6.5
and high platelet count, 514 where 150-400 is normal.

I'm trying to put this in context and figure out what next to do with
him. I'd appreciate any perspective or insight. This has us all puzzled.

The child acts well, eats normally (sometimes he has an appetite,
sometimes he doesn't) and has normal energy levels. He doesn't get sick
easily (and hasn't had a cold yet this fall.) He has no trouble keeping
up with his active preschool class. He doesn't need naps.

But he's got two bizarre health problems: a year ago he nearly died from a
perforated intestine and the resulting peritonitis and we have never
figured out what caused the perforations (there were several small ones in
his upper intestine.) At that time he had an ileus for about two weeks
and lost quite a lot of weight - he has regained it all and doesn't appear
to be skeletal, he's just SMALL.

The other bizarre health problem is his teeth are shot. Just before he
turned four he suddenly presented with five cavities and an abscessed
tooth. We were never lax about his everyday dental care but in the past
four months (since this problem suddenly developed) we've been totally
anal about brushing and flossing and fluoride. And yet new cavities are
still showing up and now he's up to SEVEN cavities with two abscesses.
(Well, one abscessed tooth was pulled, but now there's a new one.)

No one in the family has anything like it in terms of bad teeth. As best
we can tell the two week period where he had the ileus (and consequently
lots of stomach acid in his mouth) must have damaged the enamel in his
teeth. He occasionally has tooth pain from this but in those cases we
feed him liquid food (protein shakes, yogurt, stuff like that). We are
continuing to address his dental issues aggressively.

Meanwhile, he's still small, but this is actually a common occurance in
our family. His siblings and most cousins were at the low end or below
the weight charts. My older kids always wore their age in clothing
sizes. In the context of his illness/weight loss, steady recovery and
sibling history his size doesn't concern me... but it obviously concerns
the doctor.

So... in this context, what do you suppose a high platelet count means?

His doctor said to finish the teeth thing (that'll take two or three more
months) and then we'll retest the platelet count. The doctor didn't
discuss with me the implication of a high platelet count but I
understand it might mean CML. (I asked him specifically about the
meaning of a high platelet count but he was actively trying NOT
to scare me and didn't want to get into scary cancer talk about one test.)

If it were CML wouldn't my son appear unwell? And doesn't the white blood
count get affected by that? Would it have anything to do with his size or
his bad teeth or peritonitis? (I just can't see it!)

What do you think?

Wendy

In ,
Wendy wrote:

*I've got a small four year old. He weighs 28 pounds. Two years ago he
*weighed 26.5 pounds. My doctor is very worried about this. He asked for
*a CBC count. It came back with lowish iron: 11.3, normal white blood: 6.5
*and high platelet count, 514 where 150-400 is normal.

Is your pediatrician concerned regarding the thrombocytosis? Frankly, I
don't think it's so very high. Only 95% of "normal" patients will fall
inside a "normal" range, by the very definition of normal range, anyway.
In the absence of bleeding problems, I have a hard time imagining you're
dealing with a platelet leukemia, because neoplastic platelets are
generally dysfunctional. With a normal white count you couldn't
possibly be dealing with a chronic myelogenous leukemia, I don't think!
I know that in the dog, iron deficiency can cause thrombocytosis. Is that
not the case in humans? That would be the simplest explanation I can think
of. That, or benign reactive thrombocytosis, seen sometimes with various
inflammatory conditions.

Good luck getting to the bottom of things!

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

In article , Wendy says...

I've got a small four year old. He weighs 28 pounds. Two years ago he


If it were CML wouldn't my son appear unwell? And doesn't the white blood
count get affected by that? Would it have anything to do with his size or
his bad teeth or peritonitis? (I just can't see it!)

What do you think?

Hi, Wendy.

Those more knowledgable seem to have given you some encouraging responses. What
I have to give you is just to take everything one step at a time
through this process of differential diagnosis, and try not to think ahead of
things as much as you can avoid it. For sanity's sake.

I went through a similar scare some years ago as my son was presenting very
atypically with a single enlarged tonsil, and the ENT was mentioning the
possibility of a lymphoma. Eventually, the cause turned out to be an infection
which was persistent and resistant to antibiotics.

Sure I went to the internet and educated myself on lymphomas, but it was my
father's advice not to think ahead of the process, and best I can not to pay the
interest of worry on a problem that never came due.

One step at a time.

Cheers,
Banty