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14 Dec 2020

3 year old blood work
Hi, My son is 3 years 8 months old. Since last year (he started daycare January 2019), he has been having loads of issues. He has had ruptured eardrum, glandular fever (tested positive for EBV), iron deficiency, sinus issues every 2-3 months and most recently diagnosed with Granuloma Annulare (after punch biopsy). He also has dark skin under his eyes. His dermatologist suggested that there could be a 1% link to diabetes and we had FBC and fasting glucose levels were also tested. Paediatrician called back with results and all was good except for iron deficiency, of which we are now giving Ferrimed syrup 10ml/day. What I have seen on my sons blood results, is that his hemoglobin, red blood cells and hematocrit are raised. His lymphocytes are low. Could there be a cause for concern? Currently my son is on Ferrimed, Allergex syrup, Chocoton syrup. I use Protopic ointment for the lesions (Granuloma annulare) and Elidel 1% for a red scaly patch on his chin. My son moves his legs a lot, which I think could be due to the lesions on his legs itching, but he does not scratch it. I have looked at previous bloodwork results and noticed that witheach, his lymphocytes are low. Would I need to do further investigation on what is wrong my boy? Will appreciate any feedback.
Answer
Expert
childhood diseases
Paediatrician

21 Dec 2020

Thank you for your important questions about your son’s health. One of the problems for young children attending a daycare is that of repeated or recurrent virus infections. This appears to be the case with your son. He certainly was very young at the time to develop glandular fever.He has had repeated sinus infections. One explanation that makes him more susceptible to infections is his persistently low lymphocyte count. This is known by the medical term as lymphopenia where the white cells known as lymphocytes are lower than  normal in number, usually below 3000 in children. This makes him particularly susceptible to viral infections. The cause of a low lymphocyte count may be genetic, but there are other causes that may require investigation.Despite having a normal haemoglobin and red cell count your son has low iron levels which you are treating with Ferrimed. Granuloma annulare is a self limiting skin condition that clears up by itself, usually within about 2 years. Unless the rash is very noticeable it does not require any treatment. If it is very noticeable,a safe cortisone ointment such as Advantan used once daily and only when needed is adequate. It is not usually necessary to use Protopic or an antihistamine such as Allergex either. Importantly diabetes has been ruled out in your son. The way forward here relates to your questions about both his low iron stores and his low lymphocyte count. I would recommend that your son should be seen by a paediatric haematologist for an opinion. If for nothing else, this consultation will be mainly for reassurance.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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