Low hemoglobin in-spite of all reports are normal?

Question

My child is of 14 months. His hemoglobin was reported as 6.5 which is very low. For the root cause we performed every reports i.e. Urine,Stool,Folic Acid, B12, Iron..etc...All reports seems to be normal. After showing this reports to doctor, he suggested us to do bone marrow test. So, my next question would be,
What if this test is positive?
Is there some thing to worry?
What will be the next test?

Answer 1

God love you for coming here for an answer. I've spent over 30 years trying to help folks - but you're not going to get the answer you seek here.

I'm not seeking points here - I could pull an answer up on the Internet. But I'm not. With the labs you've given, I could make a guess - like all of the other unqualified people here. I'm not!!

You're wee one needs you. Listen to the doctors. They have the knowledge and experience to make an accurate diagnosis.

Be well. Rick the Pharmacist

Answer 2

I think you should just wait and see what the results are and what your doctor says. It is not a good idea to rely on what is said in here as far as your childs health is concerned. You worrying about it is not going to fix the issue.
Red blood cells are made by the bone marrow.. that is why this test is being done.
Good luck with it all.

Answer 3

Idiopathic Aplastic Anemia is extremely rare more so in a 14 month old baby.. Bone marrow biopsy confirms the disease. There is a lot to worry as it can be cured only by marrow transplantation. Next test is to select a suitable donor.

Answer 4

No one can guess what the bone marrow biopsy will show. I notice no tests for red cell survival were done or hemoglobin electrophoresis for hemoglobinopathies. These should be done before a bone marrow biopsy.

Answer 5

Most common anaemia in a child of your child's age is iron deficiency anaemia. This is usually dietary, however ou have mentioned an iron test - so presumably this is ruled out.

So back to basics ...

You get anaemia if you
(1) don't make enough red blood cells or haemoglobin
(2) lose too much red blood cells +/- haemoglobin

Sounds like they have checked urine and stool for sites of blood loss, B12, folate and iron for easy fixed causes of not making enough.

I'm hoping your doctor has checked: blood smear, haptoglobin, liver function tests and bilirubin to see if there is any signs of haemolysis

The site of blood cell production is the bone marrow.

If the usual tests do not yield a reason for your child to have low haemoglobin then I think the next test is to look and see if the reason for low production of blood is because of the bone marrow.

This may well yield an answer that will be very worrysome.

We are talking about: bone marrow cancers (leukaemias and lymphomas), myelodysplastic disorder, and aplastic anaemia

The next tests will depend on what the marrow shows.

Had a look in emedicine for possible causes. There are some extra things here you could Google.

Causes: Causes of anemia are either inherent in the RBCs or related to an external factor. As noted previously, these can be simplified into 3 main categories, although more than one mechanism may be involved in some anemias.

* Anemia caused by decreased red cell production (generally develops gradually and causes chronic anemia)

o Marrow failure

+ Diamond-Blackfan anemia (congenital pure red cell aplasia)

+ Transient erythroblastopenia of childhood

+ Aplastic crisis caused by Parvovirus B19 infection (in patients with an underlying chronic hemolytic anemia)

o Impaired erythropoietin production

+ Anemia of chronic disease in renal failure

+ Chronic inflammatory diseases

+ Hypothyroidism {SHOULD BE RULED OUT ALREADY}

+ Severe protein malnutrition

o Defect in red cell maturation

+ Nutritional anemia secondary to iron, folate, or vitamin B-12 deficiency {SHOULD BE RULED OUT ALREADY}

+ Congenital dyserythropoietic anemia

+ Sideroblastic anemias

+ Pure red cell aplasia/maturational arrest

* Anemia caused by increased red cell destruction (hemolysis)

o Extracellular causes

+ Mechanical injury (hemolytic-uremic syndrome, cardiac valvular defects)

+ Antibodies (autoimmune hemolytic anemia)

+ Infections, drugs, toxins

+ Thermal injury to red blood cells (with severe burns) {I'd hope this was RULED OUT ALREADY}

o Intracellular causes

+ Red cell membrane defects (eg, hereditary spherocytosis, elliptocytosis)

+ Enzyme defects (eg, G-6-PD deficiency, pyruvate kinase deficiency)

+ Hemoglobinopathies (sickle cell disease, unstable hemoglobinopathies)

+ Thalassemias

+ Porphyrias

+ Paroxysmal nocturnal hemoglobinuria

* Anemia caused by blood loss {SHOULD BE RULED OUT ALREADY}

o Obvious or occult site of blood loss: GI tract, intra-abdominal, pulmonary, intracranial (in neonates)

o Particular risk of massive hemorrhage (internal or external) for patients with bleeding disorders

Answer 6

The best thing you can do for your child is for YOU to remain positive. Don't worry about the "if's" and wait with faith that things will be okay. If you are anxious your child will pick up on this and it will not do him/her any good whilst tests are being done. So, you believe and be strong. You will both be in my prayers. Good luck.