Newbie would love your input on my kiddos bloodwork

Hi, everyone! My name is Carmen and I am the mom to 3 great kids ages 17mo, 4y, & 9y. We live in the US and I am researching the possibility of thalassemia in my 17month old son, Killian. Our family consists of irish, german, & native american descent, however my father is Cuban, with Spanish, puerto rican, and probably african descent.

In November, he spiked a temperature of 106* for 3 days, emergency visits resulted in a diagnosis of a 'virus'. He received IV antibiotics + 2 in office injections. Since that time, he has had 9 more fevers with the latest (of only 100/102) resulting in 3 febrile seizures in a 30 minute period, the final seizure was stopped with Valium via IV in the ambulance. His hemoglobin in the ER that day was 8.3. Two days later in office it was 7.7 (finger stick) & we were sent to the ER where it measured 8 (CBC/vein draw) & we began iron therapy. Follow up bloodwork 2 days later (CBC/vein draw)  showed 7.8. Since the febrile seizures, he has been 'dancing' in his sleep moving constantly (arms, legs, shoulders, hands, feet/toes, eyes, head). An EEG was 'normal' with 'drowsy bursts' ruling out seizures while he sleeps.

He is breastfed on demand and eats a lot of other foods-- he LOVES broccoli, asparagus, brussels sprouts, meats, etc. (Stuff most kids wouldn't touch). I am not anemic. Intermittantly over these months he has had hives which we thought were our dog so we rehomed her, and now it looks like there is also a corn allergy.

I have created a google document to help sort out all his values-- the doctor seems frustrated about why he doesn't seem to be absorbing the iron (?). The google doc is at: https://docs.google.com/document/d/1bsG0y0kVn9EcRlk6TVIIs-oo7_Scqdm7MRe_zMOPPXA/edit?hl=en_US. Yeah, I named it Killian Syndrome, lol!

I would love a look from someone who has more experience with this. The document lists values of his labs in the ER in nov, the 1 value i was given the day of the seizures, our 2nd er trip (different hospital) and our followup with the doc. There was a mention that his iron was '13' at the 2nd ER visit, but I didn't include it as I don't know exactly what value it should be listed as... (serum iron or saturation or another value?). Also listed are the blood smear results. I've listed some tests and info at the bottom of it all as it was what i was thinking of asking her about. After some reading, I listed the rbc/mcv ratios as well.

Our doc wants to do an MRI tuesday due to the originial back to back seizures diagnosed as febrile. i was ok with this until I looked at his labs.. i think we need to worry about his blood first... She is a great doc and has been quite helpful.

I'm sorry if this is in the wrong forum-- I didn't feel like I have enough info to put it into the others. Thank you in advance for ANY directionn you can give.

Hi mommyrox,

Do you have any record of his Hb before this problem presented? And has he ever been fed fava or broad beans? Other beans and legumes, including peanuts? Has the possibility of G6PD deficiency been investigated?

His results look very much like IDA, but alpha thalassemia must also be investigated, although testing at birth should have revealed some hemoglobin barts if alpha thal is a factor.

Thank you so much for your quick reply, Andy!


He has had less than a handful of peanuts and a few Tbsp of peanut butter /after/ all this started (while we were cutting out corn & i was finding other snacks for him). Only others are green beans, a taste of chickpea, an edamame bean or two. My husband doesn't eat beans (they give him nausea) other than string beans, so it's not a foodgroup i often serve.

From speaking with the doc, yes, the november hemoglobin is the first we have. (He has been a very well child with the exception of newborn jaundice which we used a biliblanket for. This occured during a snowstorm, so the use & ability to get to the doc for heelsticks took a but longer than what i consider normal).

His recent reports all point to IDA. The only form of thalassemia that would give similar values would be the HbH disease of alpha thal and this would most likely have been noted at birth with routine testing for hemoglobinopathies. Hemoglobin barts would have been discovered and at his current age, HbH inclusions should have been found in electrophoresis if he did have HbH. In addition, both parents would have to be carriers for HbH to be present. Also, recent analysis of several studies came to this conclusion.

http://cpj.sagepub.com/content/48/4/420.abstract

Conclusion. Children with febrile seizures were almost twice as likely to be iron deficient as those with febrile illness alone. The results suggest that screening for ID should be considered in children presenting with febrile seizure.

http://www.ncbi.nlm.nih.gov/pubmed/21103365

in a meta-analysis that combined all eight case-control studies that have examined the association between iron deficiency and acute/febrile seizures to-date, iron deficiency, described in 310/1,018(30.5%) cases and in 230/1,049(21.9%) controls, was associated with a significantly increased risk of seizures, weighted OR 1.79(95%CI 1.03-3.09).
CONCLUSIONS:
Iron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.

He has a good varied diet, but he is not absorbing iron. I would suggest an investigation of celiac disease, as this can reduce absorption of nutrients greatly. A recent thread where a beta thal minor child also has celiac can be seen at
http://www.thalassemiapatientsandfriends.com/index.php/topic,4061.msg40459.html#msg40459
This child's Hb and iron levels have improved greatly since strict adherence to a gluten free diet has been followed.
Absorption issues must be investigated.

Thanks for all your insight, andy!
The doc & i agree that sometng would have had to somehow be missed for this not to be picked up in his newborn testing, but i guess there's always a possibility.

You are the third person who has suggested celiac but our doctor seemed a bit apprehensive about doing the test. Possibly because he isn't losing weight (has gained since this started, in fact) and has no other symptoms?? I did notice his b12 is a bit low, but his folic acid was normal. She is being exceptionally easy to work with and offered to do any testing monday when we go in for his pre-mri appt.

I am just grasping at anything I can think of right now... I think I will request the labs from the ER visit due to the seizures to see how the other values relate to the other results I have. I'm just so lost-- I am losing sleep and can't relax feeling & seeing him twitch from the anemia.... I don't want to ignore any possibility at answers for what is going on with him. Again-- thank you so much for the immense knowledge you're sharing with everyone here-- & to do so in Lisa's honor.. Well, I can just imagine what an amazing person she was.