I ask to give advice or council

[SVB]

To the child 210. The analysis of a blood from 28.09.04 on background ORVI: WBC-2,6; Hgb-100; LY-61,4; MO-5,1; GR-33,5; RBC-3,8; Hct-30,9; MCV-81,3; MCH-26,3; MCHC-324; RDW-12,1; PLT-232; MPV-7,5; Pct-, 174; PDW-16,1; an ESR-46; (/:-1, -1, -14, -82, -2) Were treated in hematology unit RDKB of 2 weeks from ORVI. d/?: simptomat.lejkopenija, zhelezodef.anemija, a neutropenia. The analysis 27.10.04: WBC-3; Hgb-105; LY-50,9; MO-11,7; GR-37,4; RBC-4,25; Hct-33,9; MCV-79,6; MCH-24,8; MCHC-311; RDW-13,7; PLT-347; MPV-6,8; Pct-, 237; PDW-16,3; an ESR-36; (/:-1, -4, -14, -66, -4, .-2; ....-9) In a week (3.11.04) have rung out in a hospital with pravost.ochag.pnevmoniej. The analysis from 4.11.04 the Heme-94, .-4, .-4,9, an ESR-49, (-1, -2, -1, -30, -62, -4) the Analysis from 15.11.04 the Heme-100, .-4,18, .-2,2, an ESR-25, (-1, -4, -2, -12, -41, -10) the Analysis in *quot; ?O?a?y??*quot; a status from 15.12.04 WBC-3,4; Hgb-110; LY-61,3; MO-9,9; GR-28,8; Hct-35,6; MCV-78,1; MCH-24; MCHC-308; RDW-15; PLT-286; MPV-7; Pct-, 201; PDW-16,7; an ESR-15; (/:-2, -8, -16, -73, ..-1) the Hematologist is silent. Where to us to move?

[OlgaMar]

Dear SVB,

It would be desirable before to give or allow any advice or council to receive series of answers to following questions:

1. Than were treated in RDKB

2. Duration of treatment

3. What researches were spent besides the analysis of a blood

4. What references at an extract from RDKB

5. That the child when was ill or sick with a pneumonia received

6. As the child (what particularly products enter into a ration) at the moment eats

7. Whether accept any preparations at present

Yours faithfully

[SVB]

Dear Olga! Thanks for the answer!

1) Treatment in RDKB symptomatic: Aekol, Cametonum, TSefekon, Boramentol

2) In a hospital were from 29.09.04 till . Actually the first reference or manipulation to the pediatrist in occasion of ORVI was 16.09.04. After 10 days of unsuccessful treatment under observation uch.pediatra, it or he (the pediatrist) had been gave a direction on full an.krovi (28.09.04) after which has come running zav.poliklinikoj with a direction in a hospital to a hematologist. 3) biochemistry from 30.09.04 the General or Common fiber 61,8; .-55,9 %; Alfa1-6,34 %; Alfa2-13,4 %; beta-9,05 %; gamma-15,2 %

From 30.09.04 L-..-0

From 30.09.04 Fe-5,38, -58,6; -9,18 %

After an. From 05.10.04 Hb-121; -3,5; -409; the ESR-40 have been written out home with the formulation: vsvjazi with *quot; ???ON?y?*quot; dynamics or changes.

4) It is recommended: a dogrose, Polyvitaminums, eleutorokokk, bioparoks, nazivin.......

5) the Pneumonia has begun on a background o.otita. Treatment of a pneumonia: Cefazolinum, fankarol, Bromhexinum, a syrup k.solodki, viferon.

Enterobiosis-, chlamydias-, mikopl.-otr.

Biochemistry from 5.11.04 Ast-, -0,16, SRB +, the General or Common fiber 722; .-47 %; Alfa1-5 %; Alfa2-17 %; beta-15 %; gamma-16 %

It is recommended: Viferon under the scheme or plan.

6) the Child eats usually, appetite good, in addition a dogrose.

7) After my requests to a hematologist about doobsledovanii the direction on an integrated analysis of a blood (four weeks on 2 times in ned is given out.), US of a lien (it is not made yet).

Simultaneously the immunologist has appointed or nominated second time the scheme or plan viferona. To a kindergarten does not go since September.

Whether it is possible to estimate or appreciate dynamics or changes in a blood on a background of reception viferona?

Thanks!

[Dr. Vad]

Dear Sergey!



At your child is available zhelezodefitsit:

Low iron - Fe-5,38, and should be at this age more than 7,7; -58,6; and low saturation of a transferrin by iron -9,18 of % when in norm or rate should be 30-35 %.



Leukopenia because of a neutropenia plus disturbance bactericidal f- neutrophils at ZHD - the phenomenon neredkoe-

As the expressed anemia is not present, I recommend to begin reception pr- a gland (in recalculation on ions) in a dose of mass of the child of 1-2 mg/kg day. Better drops or a syrup - to dose out in connection with a varying mass of a body easier. To wash down something with rich vitamin C (juice without a pulp). Uvelichte in a ration of the child volume of meat nutrition. In 2-3 weeks peresdat the analysis of a blood also it is desirable with definition of reticulocytes - at the normal answer should raise or increase. Then further reception in this dose, will not cease to rise yet a hemoglobin; after that a maintenance dose of weight of 0,8-1,5 mg/kg within a year. Store or keep -you gland far from the child, dose out strictly on mass of a body - children of small age are easily acquisitive to an overdosage. If the hemoglobin will not raise or increase - communicate or be bound - we shall solve.

[SVB]

Thanks! We shall be healthy!

[OlgaMar]

Dear SVB,

I ask a pardon for a delay with the answer as was away. Whether from your letter has not understood the child received any preparations in connection with iron-scarce an anemia, being in a hospital. It completely agree with the colleague - an anemia it is necessary to treat medikamentozno + special attention to a diet (I not simply asked you about her). Later 3 weeks from reception of iron hand over the analysis of a blood. How the child now feels? Whether you give him viferon? (however to me the sense of its or his purpose or appointment, both on a background of antibacterial preparations, and after) is not so clear.

Yours faithfully

[SVB]

Hello, Olga!

I congratulate you on a holiday on March, 8th!

We have started to accept iron preparations. Till last moment for some reason nobody appointed or nominated them. The diet has been recommended only. But probably, the reason not in a delivery, and in nedoobsledovannosti. ZHelezodefitsit in itself and the leukopenia to arise spontaneously not can. It would be desirable to hear from you opinion on this question.

In general there was an opinion that we have not met the doctor who could incur the responsibility and is system to send on experts. The local pediatrist from our leucocytes in horror also it is ready to send us anywhere and to everybody. A hematologist not studying or investigating a map and history and 15 seconds, having looked or seen analyses has sent on delivery repeatedly within 3 weeks 2 times a week and on consultation to the immunologist. The immunologist at all did not begin to look a map, has sent on an immunogram, after has appointed or nominated viferon. And even in words nobody is interested in purposes or appointments of colleagues. We are written down on reception to a hematologist in the extremity or end of this week. Prompt as correctly to spend conversation with the doctor in our situation?

[OlgaMar]

Dear SVB,

First of all many thanks for congratulations. And now to a question on a status of the kid. What iron preparation is received by the child, in what dose? When last analysis of a blood has been handed over? If 15.12.04, it is necessary now peresdat (it completely agree with Dr. Vad it is desirable with definition of reticulocytes to check efficiency of an accepted preparation), and also serumal iron and OZHSS. Besides it or this I would advise to make US of a liver and a lien, and also (at a saved low hemoglobin) to hand over a feces on an occult blood. And more at me 2 questions. The first - whether is imparted or vaccinated the child and the second - a status of integuments - whether is not present on a body periodically arising sinjachkov, *quot; vascular ?oN?n?N*quot;? In occasion of viferona I can tell or say, that a preparation good, but for its or his purpose or appointment it is simple so with the purpose that is called, *quot; maintenance ???O??ONOa*quot; does not approach or suit. It is better to use vitamins (with what what iron preparation depends on that receives the child) or medicines specially intended for it or this.

Yours faithfully

[Dr. Vad]

Dear Sergey!



From itself to add it would be desirable for the following: reticulocytes raise or increase about 4-5 days after successful therapy by peroral iron with peak value or meanings;importance for 8-10 days - knowing when you have started to give preparations, it is simple to count up, in what days it is better peresdat obshch. an. Bloods with reticulocytes; repeated definition syv. A gland sometimes I practise on a background of purpose or appointment pr- a gland for an estimation of its or his absorption, but it is meaningful right at the beginning of therapy (2-3 days), after a week-two it is more expedient to estimate or appreciate either reticulocytes or a gain of a hemoglobin.

In my representation, at children it is more expedient to check up all over again presence helikobakternoj infections, especially if there is no dynamics or changes either in retikul., nor on a hemoglobin, tk at them unities. Display of this infection can be ZHD an anemia:



Russo-Mancuso G, Branciforte F, Licciardello M, La Spina M.

Iron deficiency anemia as the only sign of infection with Helicobacter pylori: a report of 9 pediatric cases. Int J Hematol. 2003 Dec; 78 (5):429-31



Kostaki M, Fessatou S, Karpathios T.

Refractory iron-deficiency anaemia due to silent Helicobacter pylori gastritis in children. Eur J Pediatr. 2003 Mar; 162 (3):177-9.



From nutritivnyh (in view of absence of an opportunity of their definition in a blood in our territory) as already mentioned, it is necessary to pay attention of components to copper and zinc additives:

For children of the first years of a life a dose of Zincum 3 mg/kg/d of zinc sulfate providing 0.7 mg/kg/d of elemental zinc; for copper - 80 mg/kg/d (42-135 mg/kg/d).



Role of copper in a hemopoiesis and not only:



Copper deficiency can result in the expression of an inherited defect such as Menkes syndrome or in an acquired condition. Acquired deficiency is mainly a pathology of infants; however, it has been diagnosed also in children and adults. Most cases of copper deficiency have been described in malnourished children. The most constant clinical manifestations of acquired copper deficiency are anemia, neutropenia, and bone abnormalities. Other, less frequent manifestations are hypopigmentation of the hair, hypotonia, impaired growth, increased incidence of infections, alterations of phagocytic capacity of the neutrophils, abnormalities of cholesterol and glucose metabolism, and cardiovascular alterations.



From Am J Clin Nutr. 1996 May; 63 (5):791S-6S.

Copper as an essential nutrient.

Olivares M, Uauy R.



The full text dr. The review http: // www.ajcn.org/cgi/reprint //67/5/1012s



On Zincum:



Regular zinc supplements can greatly reduce common infant morbidities in developing countries.

Zinc deficiency commonly coexists with other micronutrient deficiencies including iron, making single supplements inappropriate.



From Zinc deficiency: what are the most appropriate interventions?

Roger Shrimpton, and co-workers. BMJ 2005