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These showed up on my DS16's anemia profile that was done 1.5 weeks ago. Yesterday family doc was concerned and gave us the name of a hematologist. Hematologist wants to see us tomorrow - I am worried. I have never had an appointment scheduled so quickly with a specialist.

 

LLMD says these cells have shown up in a handful of other patients who have Babesia. Let's hope that's the case for my son.

 

Anyone else have experience with this?

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Thanks for all of the encouragement. The appt went really well. The hematologist was very progressive - she accepts PANDAS and Lyme & Co and long-term abx use. She said that there are studies showing long-term abx use is actually safe for some people and that in my son's case the benefits outweigh the risks. She did feel like the meds could be affecting his bone marrow, especially the anti-parasitics, which she said can cause the nucleated RBCs to leak into the blood.

 

She will be following him monthly since his neutrophil and platelet counts are always very low. She said I am to contact her directly if his fever goes above 100.4 because of his neutropenia - she is basically treating him like a cancer patient since he is at high risk for infection - specifically a central IV line infection. (Cross my fingers, he has had a central line for 2 years and no infections).

 

She may do a bone marrow aspiration at some point to check the marrow, but said it is not warranted just yet.

 

I was shocked that a specialist could be so helpful and understanding. I have hit so many brick walls with specialists and have had to defend my son's treatment when a doc hasn't understood PANDAS or Lyme.

 

Slowly I am building a team of docs that understand my son and are willing to help - we have a supportive family doc, a very smart LLMD, a chiropractor, an integrative dentist that does ART, and now a hematologist.

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She said that there are studies showing long-term abx use is actually safe for some people and that in my son's case the benefits outweigh the risks. She did feel like the meds could be affecting his bone marrow, especially the anti-parasitics, which she said can cause the nucleated RBCs to leak into the blood.

 

 

Wonderful news! Thanks for sharing the above information.

 

Sorry these are from vet med articles:

 

https://ahdc.vet.cornell.edu/clinpath/modules/hemogram/NRBC.HTM

 

Nucleated red blood cells can be seen in peripheral blood (called a normoblastosis or erythroblastosis) under the following situations:

  • Regenerative anemia: In this case, the nRBCs will be accompanied by polychromasia or a reticulocytosis.
  • Bone marrow injury, e.g. endotoxemia, lead poisoning (plumbism)
  • Bone marrow neoplasia, e.g. primary myelodysplasia, acute myeloid leukemia
  • Extramedullary hematopoiesis
  • Altered splenic function, e.g. splenectomy, splenic hemangiosarcoma

I thought this was interesting too:

 

nRBCs are counted (regardless of technique, i.e. manual or automated) as white blood cells (WBC). For this reason, the obtained "WBC" count (from an analyzer or a hemocytometer) is actually a nucleated count which includes WBC and nRBC. The obtained nucleated count must be corrected for the number of nRBC in the circulation.

 

So nRBC could actually be skewing a high WBC result.

 

http://www.dcavm.org/10may.html

 

There are three major causes of anemia: 1) Loss of red blood cells 2) Destruction of red blood cells and 3) Lack of production. Anemia can also be categorized as regenerative or non-regenerative. A regenerative response is defined as production of new red blood cells that is appropriate given the degree of anemia. Regeneration can be identified on a complete blood count and differential as a high MCV (new RBCs are larger), polychromasia, anisocytosis, reticulocytes, and nRBCs.

 

Destruction of red blood cells can occur for a number of reasons. Destruction may be secondary to blood borne parasitic diseases such as Babesia canis or Mycoplasma hemofelis or infections such as FeLV.

 

Just my thoughts that this could apply to humans as well.

 

Did she consider that babesia infection might be another cause for nRBC production?

 

I'm just thinking out loud here because I am considering babesia/protozoan infection as another piece of our puzzle. Another thing to learn about.

Edited by rowingmom
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Wonderful news. Glad you are in good hands with your team of Dr.'s. Others I know have not been so fortunate with Hemotologists.

 

You might also want to have your LLMD check for the protozoa 'FLT 1953' via Fry Labs (its a DNA test). It is a red blood cell parasite and maybe contributing to his issues.

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