Where Have all the Neutrophils Gone?

I had mentioned in my last post that Parker had become neutropenic in the past month. We had originally hoped that it was tied to a medication he was taking, but that was not the case. Our immunology team has decided to ask the haemotolgy team for their expert opinion. They have visited Parker and reviewed his complete blood count. There are specific things that they will try and rule out before we assume it is only tied to the ADA deficiency.

First some forms of neutropenia can be heriditary. This is extremely rare and we believe it is very unlikely. ADA and Congenital Neutropenia, who wins the lottery twice? To rule this out, they will take a blood test from my wife and I and check our neutrophil counts.

Secondly, it could be caused by some virus. They will do a blood test on Parker to see if that is the case. If it is, we will just have to pretty much wait it out until it goes away.

Thirdly, there could be a problem with his bone marrow. I am not completely up to speed on what they would be looking at but they will have to do a bone marrow aspiration to test for it. It would consist of a needle puncturing his bone and removing some of his bone marrow. It would be done unter a local anestha; however, he would find it quite painful once it is done. He would most likely receive morphine (orally) to combat his pain.

The blood test on Parker will be done tomorrow. We are currently waiting to hear from the immunology and haemotogy teams to see if it is necessary to do the bone marrow aspiration tomorrow or after he has been on the PEG-ADA for a while.

Everyone is hoping that Parker neutropenia is related to his ADA deficiency. If it is then the PEG-ADA should remove the toxins and increase his neutrophils. Although I have not read any literature about of this yet, I have just recently heard of one case where the ADA caused the child to be neutropenic. The PEG-ADA alleviated that problem.