WBC normals?

April 30, 2010 at 3:34 am

Hi, at the children’s hospital where I work, for a 2 to 6 year old child, normal WBC is 5 to 17; for a 1 year old 5.5 to 17.5, and for an adult 4.5 to 11, so Selah’s 5.1 would be in our normal range. I know that as a specialist in this field, I would not worry about a 5.1 just for that number. Every person has their own “normal”. It sounds like Selah’s may be on the lower end of the general population and this is fine as long as the kinds of cells are good and how they work is good. These two things are more important than just the number. Are her number of neutrophils (also called polys and bands or PMNs) normal (these fight bacterial infections), the number of lymphocytes (that fight viral infections) normal, and the number of monocytes (that help clean up) normal? You have said before that they were looking at the B and T cell subsets–this tells that there are plenty of the different subtypes of lymphocytes–and mitogen stimulation studies–this looks at how the lymphocytes work after being challenged with a “mitogen” like Candida–to make sure that the lymphocytes will respond appropriately to a challenge like this.

One of the known side effects of immunoglobulin is leukopenia (a lowered WBC number) and also transient neutropenia–a lowering of the number of cells that fight bacterial infections briefly after the IV IgG is given. I have not ever seen the latter, but rarely see the former.

As Dawn says, other medications can affect the WBC as can chronic infections (making it higher or lower). It is also relatively common with rheumatologic diseases to see a lowered WBC.

I would not get worried about the fact that the WBC is 5.1–I think Selah’s doctors are worried because there is concern not as much about the number as about the fact that the WBCs are not acting completely normally–that they are not clearing this parvoviral infection as they should.

Regarding the headaches–it is also pretty common to have headaches after IV IgG administration. We give a lot of immunoglobulin in the clinic where I work and see this pretty frequently. Things that can help are benadryl (since it acts like an allergic-type reaction to the immunoglobulin) or ibuprofen or better Aleve. Sometimes people also give hydrocortisone (or other steroid) before IV IgG, but I would think they would not want to do this with Selah because it can further affect the immune system–especially the lymphocytic immune system. Another thing that can help with IV IgG reactions is making sure that the IV IgG is not given too fast–a lot of us (GBS/CIDP) cannot tolerate getting IV IgG at as high a rate as someone getting for other reasons. typically for children, the rate is started slowly–at 0.4-0.5 ml/kg and then slowly increased. A lot of the people on this site have before said that they cannot go faster than 1 ml/kg whereas some people get immunoglobulin at 4 ml/kg (most kids where I work get 5% IV IgG and start at 0.5 ml/kg for 30 minutes, then 1 mg/kg for 30 minutes, then 2 ml/kg for 30 minutes, then 4 ml/kg until done). Again, Selah may not be able to go this fast. Please ask to try ibuprofen or benadryl (or both) premedication and a slower rate and see if this helps. Kevie used to take Aleve (naprosyn sodium) and benadryl for two days after the larger doses of IV IgG, I think. Naprosyn (sodium) seems to work better than ibuprofen for the headaches for IV IgG, but I have not seen it as a liquid except as a presciption medicine–so Selah would have to get a presciption for it. Also some kids need more than one dose of benadryl or non-steroidal to keep headaches at bay after the IV IgG. The important point is not to accept that headaches are inevitable–but to try different methods (benadyl, non-steroidal, and changes in rate (or even steroids if absolutely required) to help this to be tolerable.

Finally, headaches when you bend over can also be from sinus problems. A three year old has fewer sinuses than an adult. Typically the headaches of a brain tumor are bad headaches when someone wakes up in the morning. Since the headaches come with the IV IgG–it is far, far, far more likely to be due to this especially with all the other components of Selah’s medical challenges.
WithHope for a cure of these diseases