significance of sgpt (alt) and creatnine in thalassemia intermedia

My daughter 2.5 yrs old is taking HU 3.5ml daily along with folic acid , vitamin e, vitamin b complex and calcium. Today we got her test results of cbc , sgpt and Creatinine level. She started HU on June 1 2013 , she took  it for 2 weeks and then stopped for 2 weeks due to various infection/ fever. She has been back on HU for the past two weeks. Her current dose of HU is 15mg/kg. Her results are as follows :

                Now (3.5ml HU)         During infection.     With HU (2.5 ml)        before HU
Hb.                          6.6                        6.2                                    6.8                           7.4
Retic count.             4.5%                 ------                        2.5%                         10%
N.R.B.C.                    3
Sgpt(alt)                   35 normal range upper limit is <35
Creatinine.               0.2 normal range is 0.3 to 0.5

I have a few questions if Andy you can clear them up for me.
1. What does N.R.B.C result of 3 mean? My understanding is that's its nucelated red blood cells. Are they normal in thalassemia intermedia. What do they indicate?
2. What is the significance of sgpt (alt) test? What does her result of 35 touching the upper limit mean for her? Should I be worried ?
3. What does a low Creatinine level indicate? Is her result of 0.2 very low? Once again should I worry about it? What does it indicate ?
4. Is Retic count going up good for her?

I want to understand all these things so that I can mange my baby better. Plz do reply to me. Thanks in advance !!!!

1) NRBC's are present in thal intermedia and major and the level usually will drop if Hb is raised by transfusion or by HbF induction as with hydroxyurea. The level is not significant.
2) The ALT range is insignificant. 35 is not high. Normal range is 20-60, but medications will not be stopped by small increases in ALT. This level can actually be much higher without posing real danger.
3) Creatinine levels are lower in people of small stature. If it was high, then it can be a problem.
4) You want to see the retic count drop and it has from 10% before the HU was used. It probably increased a bit because the Hb had dropped during the illness.

Make sure she stays well hydrated.

Thanks Andy for taking time to answer all my questions in detail.

Hi Asma,

Why you change the HU dose from 2.5ml to 3.5ml?
Increas dose of Hu may reduce the blood count and Hb.
I have seen with my son, when we use to give him 250mg hydrea Hb was around 7 and RBC is aroud 4, but when i icreased to 330mg, RBC fall to 3 to 3.25 and Hb aroud 6.5.

Any such experience with others please share.

Regards,
Dip

Hi dip
Actually when my daughter was taking 2.5ml HU her hb dropped from 7.2 to 6.8 . Her doctor is the leading expert and researcher over here. His publications have been printed in American journal of pediatrics and hematology. His name is Dr. Tahir shamsi. Maybe some of you have head of him. He says his research shows that most patients showed best results at 16mg/kg. Of course hr said dome respond better at lower or higher doses. So that is why he increased her dose. I guess we all have to try and see what's best for each child. All the best to you and your family.

Regards
Asma

Hi, I just wanted to know what HU 2.5 ml means. I understand that HU means hydroxyurea and its dose is mg/kg. Can you please tell me what it means.
Thanx
Pooja

Hi pooja

What I meant was that I dissolve a 500 mg capsule of hydrea in 10 ml water and then give my daughter 3.5 ml of this. I used to give her 2.5 ml like this. Hope this clears up the confusion for you.
Regards
Asma

Hi Asma

so  your initial dose was 125mg and now it is 170mg.
What is the weight of you child?

Dip

Hi dip
My daughters weight is 13 kg. And I am not good in maths so don't really understand the mg conversion you did for her dose
All I know is that know we have apparently put her on 15mg/kg dose.
Oh can u tell me how did u calculate this mg dose ?
Regards
Asma

Hi Asma, thank u for clearing that up. Also 15mg/kg means that if ur child is 1kg then the dose of ur child is 15mg. Now since ur child is 13kgs the dose is 15 multiplied by 13 which is 175kgs. Also if u r dilting 500mg capsule in 10ml water the 2.5 ml means 500/10 multipled by 2.5 which is 125.5 and by 3.5 means 175mg. Hope this helps
Pooja

Thanks pooja for explaining the maths to me. I was really wondering how it works.

Regards
Asma

One month update

I got alyshah tested again for cbc, Retic count, sgpt ( alt) and Creatinine. Here are the results

Hb 6.7 previous was 6.6
Retic count   still waiting
Sgpt (alt).     120 previous was 35
Creatinine 0.2 same as before

Andy my question is should I be worried about sgpt being so high. I am really worried now . Still need to see her doctor. She is taking 3.5 ml at 15mg/kg .

Just talked to alyshah doctor. He has ordered a PDT done for her immediatly. I am just so worried and depressed. Does her high sgpt (alt) 129 mean she can't take HU anymore. Cam we decrease her dose of it. What can we do as her parents. I want to do the best for her. Can someone tell me what this all mean.

It's up to the doctor whether or not you can continue with HU. I think that at the least, a break should be taken. I will state again because it cannot be stressed too much. Hydration is essential. With HU or Exjade, this applies. The patients must stay well hydrated at all times.

Thanks Andy. We just got her LFT tested. What are the key things in LFT that we should pay attention to.