What are the causes of infant neutropenia?

Question

Hello doctor,

My baby boy is 3.5 months old. When he was 38 days old, he got a fever. I went to the hospital, and the doctor said any infant who has a fever without any other symptoms may have meningitis, so a lumbar puncture was performed. It was positive, and the WBC was 570 (clear), monomorph 80%, and polymorph 20%. Though the culture of CSF was negative, no bacteria were found.

He was put on Penicillin and Cefotaxime for two days, but the fever did not settle down. Then, Penicillin was replaced with Vancomycin, and the fever finally went away. He was on Cefotaxime and Vancomycin for 14 days. Then, CBC and differential had been tested, and the neutrophils were low. It read 0.6. The next day, before my baby was discharged, it read 0.7.

The doctor said that as long as it kept raising there was nothing to worry about. A week later, the same test was done, and the neutrophils were 0.9. Two weeks later, it read 0.6 and then 0.9 and 0.6 in an interval of every two weeks. It kept raising and decreasing, but overall it is still very low.

I have not noticed any viral infection other than sometimes he gets red eyelids and teary eyes, but it disappears within a few hours. He usually rubs his face, eyes, nose, and ears, especially when he wants to sleep. When he was in the hospital, I found a soft lump on his head. We did an MRI, and the doctor said it is just a hematoma.

He was born by an emergency C-section. I visited a pediatrician today who encouraged me to meet a hematologist. What is the reason behind neutropenia? Also, he has high lymphocytes of 7.70, lymphocytosis. Could it be something serious? I have attached his final test reports. Can you see anything else? Please help us.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query and attached reports (attachment removed to protect patient identity), my opinion is as follows:

Your baby boy probably had viral meningitis, looking at the positive WBC and high monocytes, along with a negative culture. Now that he does not have any fever shows that he has responded very well to the treatment.
The count of neutrophils is usually low in infants, and monocytes are usually high. Additionally, the neutrophil range keeps on varying with the day of the week, stress, any associated infections, etc.
The major worry would have been bone marrow depression, if any, or any infection. As neutrophils are being maintained above the critical 0.5, there is nothing to be worried about.
If there is any bacterial infection and the count is not raised, then it is a worry. All other values are good, so the bone marrow function is good.
Also, as the lymphocyte count is high (which is normal up to 4 years and it peaks around six months), relatively, the neutrophil count appears to have fallen. Unless he has an infection, these counts are totally acceptable
There is no need to repeat the test unless he has an infection. Repeating it every week will not change it, and it should be done only if he has an infection.
Red eyelids and teary eyes might be due to exposure to dust or crying. Nothing to worry, he is in good health.

Routine evaluation is not necessary. Repeat complete blood count after three months or if there is any infection.

I hope this helps.

Please revert in case of further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Bone marrow is not affected. If it were to be affected, hemoglobin, platelet counts, and total white blood cell counts would have fallen.

Yes, antibiotics can affect the marrow at any age group; however, here it is not affected.

These counts are totally acceptable, and no further tests are necessary. The internet will show plenty of things, and we always notice the bad things first.

This is very much within normal range, and he is in good health.

The vaccine can be given. He is not immunocompromised or anything. His immunity is good. He might get a mild fever, which is normally seen after vaccination and can be controlled with Paracetamol.

Increased WBC in CSF (cerebrospinal fluid) usually means meningitis. Here, the blood report is normal, and so I cannot think of anything else.

There is no need to protect him. His neutrophil count is good enough to ward off any bacterial infection. He is in good health, and you need not worry.

I hope this helps.

Please revert in case of further queries.

Thank you.