Case 96 – update 1

This 13 month old boy was born at 39/40 by normal delivery. His birth weight was 2.6kg. He is normally fit and well with no significant problems and no previous hospital admissions. He is up to dates with all his immunisations. He was exclusively breastfed till 6 months of age. There is no significant family history and his 5 year old sister is fit and well.

There have been no fevers, but vomiting a couple of times a day and green loose stools 1-2 times per day in recent weeks.

On examination, there is no lymphadenopathy, though you can feel a 2cm liver and a palpable spleen tip. There is no petechial rash. You suspect the rash on the arm could be an abscess but you are not sure. There are the odd basal crackles on chest auscultation. You also think he may or may not look slightly unusual.

You admit him for dietitian input and to establish a feeding plan.

You get these initial blood results:

  • Hb 85
  • Platelets 52
  • MCV 89
  • WBC 35
  • Neut 14
  • Lymphocytes 11
  • Monocytes 8.3
  • U&Es and LFTs are unremarkable. CRP 22, ESR 15.

Questions:

1. What do you think of these results?

2. What further information & investigations would you like?

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