Question about son's lab results

Patient : I was able to get copies of my 7 year old son's last two blood work results. I'll share the results, and I have some questions. The first round was taken Feb 4/15, when my son presented with a VERY high fever and headache. This was his third random 12-24 hour fever in a month or so. He's also had some mildly enlarged lymph nodes (groin and neck, his doctor ran labs Dec 30th as well, but I don't know the results from it. I do know his HGB was on the very border of normal, low-end). He's been quite pale, and had horrible circles under his eyes. Some days are worse than others. He has energy and is playing great and seems to be eating fine. He does complain of night sweats at times. I'm posting his Feb 4th values on the right, with the redrawn labs on the left (they drew extra things on the second time). Normal values are in parentheses. I've marked the ones that were Low or High. TEST Feb 4 Feb 17 Normal Range LKC 5.6 4.5 (4.0-10.0) ERC 3.61 Low 4.17 (4.00-5.20) HGB 108 Low 121 (120-160) *still barely normal HEMATOCRIT 0.307 Low 0.359 Low (0.360-0.480) MCV 85.2 85.9 (80-94) MCH 29.9 28.9 (24.0-31.0) MCHC 351 337 (320-360) EDW 12.7 12.9 (11.5-15.0) PLAT COUNT 140 Low 198 (150-400) MPV 8.0 7.4 (4.0-14.0) LYMPHOCYTE 0.046 Very Low 0.448 (0.280-0.520) MONOCYTE 0.078 0.100 (0.020-0.120) NEUTROPHIL 0.871 High 0.399 (0.350-0.710) EOSINOPHIL 0.002 0.048 (0.000 - 0.050) *higher end of normal BASOPHIL 0.002 0.005 (0.000 - 0.020) LYMPH/AB 0.26 Very Low 2.00 (1.50-7.00) MONO/AB 0.44 0.45 (0.05-0.80) NEUT/AB 4.85 1.78 (1.50-8.00) *low end of normal, has dropped EOS/AB 0.01 Low 0.22 (0.02-0.50) BASO/AB 0.01 0.02 (0.00-0.20) New Labs Added on Feb 17 RETIC 0.012 (0.005-0.015) *higher end of normal RETIC ABS 48 (10-100) NA 144 (135-147) K 4.4 (3.5-5.0) CL 108 (98-110) GLU-FAST 4.8 (3.6-6.0) CREAT 41 (30-47) IRON 11 (11-30) *barely normal UIBC 42.3 (41-77) *low end of normal TIBC 53 (41-77) TRANSF SAT (TS) 20.8 (16-50%) FERRITIN 55 (30-400) *low end of normal? B12 528 (156-698) . So.... what exactly did that first set of results mean? I know the doctor was concerned, and immediately set him up to see a specialist (which were seeing next week), even before he had the next results. I know the low lymphocytes were not good - am from what I read should not happen unless there's an "issue"? But can that happen with just a typical viral illness? And is there still any reason to be conecerned, since the lab values have come up?
Doctor :   Hello. Welcome to Ask The Doctor. I understand your concern. He has Pancytopenia. That is low hemoglobin, low lymphocy tes, low platelets. This usually occurs in following conditions: 1. Leukemia. 2. Vitamin B12 and folate deficiency. 3. Lymphoma. 4. Drugs that cause bone marrow suppression. 5. Atypical Infection. Since he has lymph nodes enlargement, fever , pancytopenia then this goes more in fever of Leukemia, Lymphoma. He would require bone marrow aspiration and biopsy and FNAC of Lymph nodes. This would only give the definitive picture that he has. He would also require Ultrasound Abdomen to see for spleen. Please note that Total Leukocyte count is also low if we say Pantcytopenia. In his case his Total Leukocyte count is normal but lymphocytes are also low so I am considering it as Pancytopenia. I don't want to make you worried. But his Blood reports and history suggests these issues only. You should take an opinion with your specialist as soon as possible. Share my opinion with him. He will post him for above mentioned investigations. I hope it helps. Stay Healthy

Comments / Follow Ups

Patient: I'm not sure if this changes the results or not, but I posted those backwards. His original results were the ones on the left on Feb 4th, and then his second labs were the ones on the right. In the second set of labs his platelets, lymphocytes and hemoglobin had come up (though hematocrit was still low, HBG was borderline, neutrophils are in normal range but on low end of it) etc...

So if those values have come up... could it still indicate something like leukemia?
Doctor: See, if they have come back to normal, they might be low earlier just due to transient infection like Ebstein Barr Virus infection.
however, it is always better to be sure.
So,i would advise bone marrow examination in such scenario.
Good Luck.

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