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colleenrn

Help with labs please

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My LLMD ran labs on my 5 year old son. His WBC count continues to be low and has been since Feb. His WBC is 3.2 (was 3.5 two months ago). His neutrophils are also low at 0.9. He was diagnosed with PANDAS at age 2-3 with strep issues. Was diagnosed with Lyme in Feb. So far co-infections have tested normal except RMSF was IgG positive.

 

BUN/creatinine ratio is HIGH at 31

 

IgG seems OK at 956 (normal is 504-1464). Not sure how to interpret the subclasses- they are normal but some are in the lower range.

 

IgG1 572 normal (292-816)

IgG2 285 normal (83-513)

IgG3 52 normal (8-111)

IgG4 19 normal (1-121)

 

IgM is low at 18 normal (24-210)

His IgG was positive for parvovirus B19. It is 4.6 Negative is <0.91 and positive is >1.1. This is Fifth's disease and it was going around his school this spring, but he did not have it.

 

ANY help with interpreting these labs is so appreciated!

 

Colleen

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His IgG was positive for parvovirus B19. It is 4.6 Negative is <0.91 and positive is >1.1. This is Fifth's disease and it was going around his school this spring, but he did not have it.

 

 

Last year my husband started having debilitating joint pain and and swelling out of the blue. He was diagnosed with Parvovirus B19, but without the classic symptoms of Fifths. In other words, he had a severe auto-immune reaction to this so I would say that this is a significant finding in the blood work! In my husbands case it did take awhile to subside. I think I should have my DS tested- this just occurred to me since my DH issues were pre DS Pandas... hope someone more knowledgeable than me can weigh in!

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My son's parvovirus level was 4.3 IGG. Doc said it should be much lower. I guess this suggests an ongoing infection. He has been taking Valtrex (valcyclovir) since last fall and it has made a huge difference in him. We all call it the magical blue pill because his behavior/mood improved not long after starting it. Lots of parents on the forum report that their kids have high viral loads.

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How long would the IgG stay elevated (his is 4.6)? Because his IgM is negative, couldn't it just be that he was exposed to Parvovirus B19? I am not understanding if this is really significant or if his IgG is elevated from exposure. It was going around his school in May and June. The more I read about the complications possible with immunocompromised people and Parvovirus, the more I worry.

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I don't know much about IGG levels and how long they stay elevated, but if I'm understanding my doctor correctly, an elevated IGG could suggest an infection that's been around awhile and is not clearing. You would want a certain level of IGG around - it would provide immunity, but too high is not good. Just my understanding, but I haven't asked a lot of questions about it.

 

Is your doc recommending an anti-viral?

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I know you said your son tested negative for co-infections, but I wanted to mention that Babesia and Rickettsia-types suppress WBC counts. My son's WBC hovers around 2.5 and has been for 1 year. We have been treating for Babesia based on clinical factors only.

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Colleen,

 

Wanted to toss out some other things for you to consider as you try to determine the significance of your child's lab results. His Parvo IgM may have tested negative because his serum IgM is low. My kids and dh are IgM deficient and we've been told that IgM results may not rule specific (acute or recent) infections in/out because their bodies do not make enough IgM, period-- so even if they had enough to mount some sort of response, what would be elevated for them still may not register as positive. IgM is the early/first line response to infection, so you may notice your child seems more susceptible or may have difficulty clearing his illnesses-- the typical presentation/progression/general course of the illness may be different for him, the illnesses may stick around longer, or he may seem to get hit harder or have a "worse case" than other kids or other family members. And just as a heads up before you talk to your child's doc-- in our experience, different doctors have different ways of approaching the significance of low immunoglobulins. For some, it's significant if it falls below the lab cutoff (so flagged low by lab like your son's was- which means it's > 2 standard deviations below norm), others don't consider it "clinically significant" unless it's very well below that lower limit. And some docs seem to rely solely on the numbers, others look for abnormal/low numbers and evidence of impairment from patient's history/patterns of illness, and others will say that history/presentation is the primary indicator of impairment even if the numbers fall within the lab's normal range.

 

The other thing that I wanted to mention in case it is relevant, relates to what mdmom posted about infections that have been around a while. I've read about IgM/IgG levels for chronic EBV and it seems that IgM may not elevate with recurrent illnesses. I believe I've read that about other pathogens, too, just can't recall the context right now. If I think of it later I'll try to find the source and post for you if it seems relevant.

 

HTH!

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I know you said your son tested negative for co-infections, but I wanted to mention that Babesia and Rickettsia-types suppress WBC counts. My son's WBC hovers around 2.5 and has been for 1 year. We have been treating for Babesia based on clinical factors only.

Thanks for all the replies. My son tested negative for both babesia. His IgG was positive for RMSF although he did not have the typical symptoms you usually see with rocky mtn. spotted fever. Now because his blood work for IgM quantitative was low, I am wondering if all the negatives for the co-infections were negative b/c he does not make IgM. How would we know? The only virus he tested positive for was parvovirus B19. Now I wonder if he could be positive for other viruses and/or coinfections and just not showing up that way b/c of his immune system.

 

I have a phone consult with our LLMD in 20 minutes. Not sure if she will want to add an anti-viral. he is currently on azithromycin 250mg per day and added in Alinia 200mg twice per day.

 

Colleen

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Just had phone consult with LLMD. Our LLMD thinks he could have babesia. She said there are over 300 strains and she can only test for two. She said that the Institute of Medicine says if all tests for co-infections are negative, BUT you have low WBC and elevated liver function, then it IS a co-infection. She said the IgG on the parvovirus B19 (Fifth's disease)is really high. That virus was going around his school all spring. He did not have any symptoms of it at all though. She feels his IgG is so high b/c his immune system is so taxed it is not getting rid of it.

She said we may possibly want to try low dose naltrexone (LDN) to boost his immune system. His IgM is very low. I have seen LDN talked about a lot on here- will have to go back and read up.

 

Colleen

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We also had Low WBC (all three) and periodic elevated liver enzymes (older son). Only one child was PCR positive for Babesia. All three have been treated or are being treated for Babesia. All three had great clinical response minus herx that can be extensive and scary. It takes 120 days to replace RBC (babesia is inner red blood cell parasite) and it took at least 4 months to see marked improvement in all three. One is on Mepron/Alinia for Babesia and has helped tremendously. Wishing all the best with treatment.

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