Prat's check up

Hi Friends

You guys will be happy to hear that Prat's hb is 10.17, his hb has been around 9 after spleenectomy in july 2008. however it did drop in Dec because of viral. For a change and for the first time ever i did not panic, and just waited for the infection to pass off.  Fortunately the infection passed off and his hb is ok.
We are awaiting his Liver function test reports and Kidney function test reports. Will post the results, i think by tomm. As of now his bilirubin is on the higher side it is about 4. I need to consult with the Dr Marwaha on this aspect.

AS for his stomach ache, he does have gastric pains once in a while and they are really bad sometimes. However over all i am happy with his progress.

Take care and God Bless.

Hi Puja,

I am really glad to hear that Prat's hb is going so well,i am sure he''l be with you soon in Singapore  .

Zaini.

Puja,

I am very happy to hear how well Prat is doing.  I wish him continued progress and good health.

All the best,

Sharmin

Puja,


It's good to hear that Prat is doing well with his Hb. Is he taking anything to induce HB, like wheatgrass? Please give my regards to Dr Marwaha.

Me too Puja, send my greetings to Dr. Marwaha

As for the stomache pains, Dr. Ali Taher has once said that after splenctomy, some patients develop very small tiny clot :hugfriends in the intestine that could cause severe pain . So it will be a good idea if you eliminate this option through an ultra sound or any other accurate test .

As for Prat's progress, i am really soooooooo happy. congratulations my friend

manal

Hi Manal, Andy, sharni and Zaini

Thanks for your wishes.

I need your advice on something:

Prat's Serum Bilirubin is :

 Total 4.57 (Normal range - .2-1.2 mg/dL)
 Direct.51(0.0-0.3 mg/dL)
Indirect4.06(0.1-1.0mg/dL)
SGOT -43.95U/L
SGPT-41.960-40U/L

The above are abnormal. Is it a cause for concern.

Rest all the Parameters like Alkaline Phosphates. Serum Proteins and Albumin and Globulin is in the normal range. Actually I was trying to upload the reports but am not able to attach.

His Kidney Function Test also seems to be ok as Blood urea, Serum Creatinine and Uric Acis is within the normal range.
Only abnormal result is rectic count. which is 8%(0.2 to 2% is the normal range).

Awaiting your advice

Thanks

Puja

Does high retic count suggests that bone marrow is over working? If so then i think it won't be strange in intermedias? As their bodies try to keep up with low hb,even if 10 is high for Prat,but still it's low,am i right? Just wanted to learn .

Zaini.

Hi Andy, Manal

Did you get a chance to review Prat's reports. i had emailed you last night.

Awaiting your feedback.

Thanks

Puja

Dear Puja

I didn't receive anything on my email till this moment and i am sorry i don't know why i missed reading this post yesterday. Sometimes when i shut my laptop before reading the unread posts, they don't appear again when i re-open.

Anyways, i have the same problem with Ahmad but he is on a low HB. I really don't know why is the retic of Prat is high though he is having a HB of 10 which i consider very good and the most important thing is  that he is on hydrea which is supposed to suppress the activity of the bone marrow.

I think Andy will be more able to answer this.

Were you able to reach Dr. Marwaha for Prat's stomach pains or not yet??

If i find anything else, i will definetly let you know

manal

Hi Manal

I will email again. I dont know how come you did not receive. i have sent it from my official id.

AS for Rectic count Dr marwaha said the same as Zaini, the bone marrow is producing the rbc's tht is why rectic count is higher. i checked his last year reports when hb was 5.91 then rectic count was 2 %.

What is Ahmad's bilirubin -  Dr Marwaha said it will be ok on its own. When I compared last year's reports again the total bilirubin was lesser(2.2) but still above the normal range. I know it is due to haemolysis but my question is how do we know that it is something worry about in these kids. in normal children if the bilirubin is slightly raised is a cause for alarm as it is jaundice. My question is that for our kids what is the level which is acceptable?

His Platelet count was also raised to 5,86,000.

Do tell me what you think.



Puja

Hi Puja

AS for Rectic count Dr marwaha said the same as Zaini, the bone marrow is producing the rbc's tht is why rectic count is higher. i checked his last year reports when hb was 5.91 then rectic count was 2 %.

But the relation between HB and the retic count (which reflects the activity of the bone marrow) in addition to bilirubin should be inversely propotional, meaning as long as the total HB is in a higher level, the retic count should decrease. Usually the retic increases when there is severe anemia because the bone marrow tries to work more hard to compansate for this low HB

As for Ahmad's bilirubin, it used to be around 1.7 for the past two years, but few months ago it started to be round 2 to 2.4 with the same HB level and with increased retic count. The only logical explaination was that (as Maha had told me ) his body is growing so it is working more harder to keep up with the same HB

But what i don't understand is that in Prat's case, a big percentage of his total HB is the fetal one because of hydrea, so why does his bone marrow needs to work so hard?

As for the bilirubin i don't think that you should get annoyed as it's increase is  due to a metaboilic reason, but from my expierence, taking magnesium plays an important role in avoiding the formation of gall bladder stones

One important thing that Sharmin has mentioned from Oakland is the importance of taking baby asprin or coumadine to work as a blood thinner after splenctomy.

As for Prat's platlets, don't worry cause a fear of thrombophilia starts when plateles reach a million and at the same time as Andy had said before, lab technicians usually mistaken the small immature red cells for platles. It happened to me several times, check them again next month to make sure they are okay

manal

Hi Puja,

The SGOT and SGPT are only on the high side of normal and almost definitely are the result of the excess bilirubin. They are of no concern at this level. The bilirubin is the result of hemolysis and this also leads to the higher retic count as the bone marrow is more active as it tries to keep the hemoglobin level as high as possible. It's a vicious cycle so sometimes you just accept that it happens and try to optimize the child's health by providing supplements and even meds like hydroxyurea to boost the production of hemoglobin and to build healthier red blood cells. Folic acid, B-complex, vitamins D and E and magnesium are all important for building and protecting red blood cells. Wheatgrass and resveratrol may help boost hemoglobin levels. You may not be able to eliminate high bilirubin levels but I think you can make a positive effect on the situation which will also lead to fewer complications in the gallbladder from high bilirubin.

Can you ask Dr Marwaha at what levels of bilirubin should you be concerned and if the higher retic count is of any concern if it also means the Hb is higher? His experience is vast and I would very much like to know what we should be advising people about when to be concerned about high bilirubin. It is very hard to compare these levels in thals to non-thals and Dr Marwaha has experience with a wide range of patients. I think he can offer some real insight into this.

Manal

if the retic count should be inversely propotional then last year prat's hb was lower and so was retic count.

 Can Vitamin E be considered a blood thinner. He is on Hydro, FPP, L carnitine, folic acid and antibiotic(Kaypan) , Vitamin E, Calcium(with magnesium and Vit D) every day .

What is the amount of Magnesium should be given.

I will keep a watch on the platelets.

Did you receive my mail on his reports.

Hi Andy

 I did ask Dr Marwaha and he said for the retic, bone marrow is trying to produce  more RBC's that is why it is higher. Also for Bilirubin, he said it will come down on its own, nothing is to be done. As for platelets he said 5,86,000 is also ok.

Also I have noticed you guys are taking abt Haematocrite - there is no mention of haemocrit in any of the reports of Prat's which have been done in India. I came across this word Haematocrite in Prat's old reports which were done in S'pore.

AS for Retic count there is no mention in S'pore reports, it seems they dont test this. All his reports done in India(recent ones and last years), have retic count. When his hb is low his retic count is low, when his hb is high his retic count is high.


Andy - Can I just let Prat be on Vitamin E and not start Asprin for blood thinner... what is your view?

Puja, retic count is the reflection of bone marrow activity so the higher it is the more active the bone marrow which is usually the case with the low anemia......... Andy please correct me if i am wrong  At the same time i know what you are talking about because i have the same situation right now,but the thing that i still do not get, is why should this happen while you are giving hydrea which is supposed to be a bone marrow suppresent

Sorry Puja for confusing you but either Andy or Dr, Marwaha will be able to answer this

Vitamin E is mainly an antioxidant, but i know it has little blood thinning properties. As for magnesium it should be half the dose of calcium.

Puja, i didn't receive the email. Are you sure you are sending the correct address

To Andy:

Is it okay that Prat is taking three antioxidants, FPP- Vitamin E-  and L-carnitine(one of it's properties is being an antioxidant)

manal