High Platelets in a 3 year old...

April 13, 2011 10:55 AM

You are not my kid's doctor but.... they are taking their sweet time getting back to me. Test details inside...

I brought my 3 year old boy in for a physical so he could go to school. Because they thought he may be anemic (from the prick the finger test) they did some blood tests. That was last Tuesday afternoon. Thursday morning they call and ask me to take him to get more blood taken to confirm results (and refer me to a local hospital to draw the blood immediately). The results are back again with similar results but the Doctor has been too busy to review the results (after they misplaced the results Friday and Monday).

He had a high platelet count (675,000 and 650,00) and high potassium . I only have the results of the second test for these: Low Creatinine, Serum 0.35, High MCH 28, High LDH 339, and high BUN/creatinine Ratio 43.

Now the doctor hasn't looked at the second results and I've called the office each Yesterday and today but they said he has to see patients all day.

I am not sure how to proceed.

posted by beccaj to Health & Fitness (16 answers total)

Wait for your doctor to get back to you and try not to worry about it until there is actually something to worry about.
posted by BobbyDigital at 11:12 AM on April 13, 2011

Response by poster: I guess I would think that way too except they told me how urgent it was for him to get to go do his second test.
posted by beccaj at 11:15 AM on April 13, 2011

You know what works? I don't recommend this unless you have tried waiting a reasonable length of time, but I do have a tactic that paid off for me.

My son's pediatrician was very busy and his office staff was the worst (he has another doctor now). They kept messing up referrals when my son needed a CAT scan and an MRI. This was especially worrisome to me as there was a possibility it could have been an issue with my son's brain, and we are talking weeks of delay here.

I tried calling the insurance company that covers us and complaining about the situation, and that did help, so I recommend that to you as a first step. The doctors need to work with insurance and they don't want to get dropped as a preferred provider.

But when it kept going on--and remember, for me this was a "going on weeks" thing--I got on the phone and would NOT get off.

"I'm sorry, the doctor is busy..." >I'll hold on the line until he has a moment.
"He can call you back after office hours" >That is not acceptable. I need to speak to him before then. I'll hold on the line.
"We have other patients..." >I only need a minute of his time to get this resolved.

By the way, keep names and dates of who you talked to and when if this thing drags on. It helps to say, "I spoke with Sandy and she said that I would have the results two days ago. What is the hold up?"

I even called the insurance company and had THEM talk to the doctor while I waited on hold. It was absurd to have to go to this extreme, but, again, we are talking about a delay of weeks.

Now, it may be they have several phone lines or they hang up on your and this won't be as effective for you.

In which case, go to the office and stay there in person until you get assistance. Be polite, but firm and maybe even loud if you have to. Doctors don't want patients in the waiting room hearing they are making other patients wait for results or messing things up.

Again, this tactic is a last resort strategy. I don't think you are there yet. But I do understand your frustration!
posted by misha at 11:22 AM on April 13, 2011 [6 favorites]

I would go get a copy of your child's records and then take them to a doctor that actually respects you and your feelings (not to mention your child's health). I think what physicians sometimes forget is that, while they see a ton of kids every day, you only see yours - and yours is pretty important.

My pediatrician's office fits us in for same day appointments regularly. We may not see the doctor we want to, but we still get in to see someone.
posted by LyndsayMW at 11:24 AM on April 13, 2011 [1 favorite]

If it were me, I'd keep calling the doctor's office and saying to anyone who will listen: "I was told that this was an emergency, and now no one is treating it as such. The fact that your office has misplaced the test results twice, along with the fact that no one will tell me whether my son is in medical danger, is making me seriously doubt the competence of your staff. What are you going to do about this?"

Hopefully, after you're put on hold enough times, someone will at least be able to get the results in front of the doctor for a quick review so he/she can tell you how urgent a response is necessary.

In the long run -- get a new doctor. This is not an acceptable level of service.
posted by cranberry_nut at 11:26 AM on April 13, 2011 [4 favorites]

Response by poster: Thanks, Misha. It's nice to think I have SOME recourse, in case, in calling the insurance co.

Unfortunately this is a one-doctor doctor's office.

I have looked into getting a new doctor. Unfortunately, the couple that have been suggested to me (that are actually taking new patients) will only you after a "well visit" and are booking out a couple of months.

Thank you for your responses.
posted by beccaj at 11:32 AM on April 13, 2011

You probably won't want to do this as it's a giant hassle for you and the kidlet, but you could go to the office (take your son along) and inquire in person. It sounds like I'm being flip, but I'm not -- if I did it, I would go anticipating that they would tell me to wait and anticipating that my child would have a harder and harder time staying quiet. Pretty soon, you've got a cranky toddler grabbing the attention of everyone in the office, and a tired mom asking the front desk, politely, for the results of the "emergency test for my baby".

Bonus points if you give your little guy a noisy electronic toy to occupy him.

Basically, create a situation where you're asking calmly for something reasonable -- and the circumstances (cranky toddler with annoying toy) are so anxiety producing that every human in the office will be falling over themselves to get you out of there.

If you go first thing in the morning or before the afternoon appointments start, the doctor theoretically won't be running behind (yet), which could make it take longer since there would be less witness, or could make it go faster since it's less of an inconvenience for them . . .
posted by MeiraV at 11:46 AM on April 13, 2011 [2 favorites]

Response by poster: MeiraV, I love that answer and I would if my Dr's office wasn't 45 minutes away.
posted by beccaj at 11:48 AM on April 13, 2011

A friend of mine got a quick response from a retail store (after several attempts) by saying "I'm only calling you again because the state attorney general's office told me I should give you one more chance."

I've never had the guts myself and can't really say whether its a good idea here --- but you get the idea.
posted by vitabellosi at 11:57 AM on April 13, 2011 [6 favorites]

Hi Beccaj,
IANYD, but I can tell you a little bit about the tests you mentioned. I will preface my remarks by noting that sometimes lab value ranges aren't adjusted for children, and so values that you're seeing marked as "high" or "low" may not actually be high or low for your child's age. For example, your son's creatinine is within normal range for a 4 year old (0.2-0.8). This link may help (contains normal lab value ranges for children). Note that having a low creatinine can make the BUN/Cr ratio high because of the way ratios work mathematically. The LDH appears to be within the normal range for his age as well.

First of all, you noted that the reason for the testing is that they were concerned your son is anemic. Anemia, by definition means that his blood counts should be low (hemoglobin and hematocrit, sometimes abbreviated Hgb and Hct). But when you reported your test results here, you did not mention what the Hgb and Hct were. This leads me to believe that they were normal. The high platelet count doesn't necessarily mean anything, it's impossible to say because I don't know your son's situation, but that's not an emergency.

High potassium, on the other hand, is a very very serious emergency and could be fatal. Again, you didn't report the number, so I can't comment on what it means. It's important to note that most high potassium lab results are due to lab problems such as the blood clotting, which is known as hemolysis. If your son's blood work result says anything about hemolysis, the high potassium could be a false result. If it's not hemolyzed and it's high, that is a huge deal and he needs to go to the emergency room NOW. I'm assuming this is not the case because if your doctor didn't get back to you with a critical result like this, it would be grossly negligent.

Not knowing what the situation is with your son, it's hard to draw any conclusion, except that you need to know that potassium value immediately and whether you need to go to the ER to get it treated. A child with a high potassium who has normal kidney function would be very very rare, so I expect that there is something erroneous about the lab result you heard. It would also help to know the numbers for the Hbg/Hct so I could give you any advice about that, but slight differences from normal range are not a big deal, while large differences, of course, are. Hope that helps and that you hear from your doctor soon. Even though he's seeing patients all day, he can and should still call you at the day's end or if he has any breaks between patients.
posted by treehorn+bunny at 1:21 PM on April 13, 2011 [3 favorites]

The fact that your office has misplaced the test results twice, along with the fact that no one will tell me whether my son is in medical danger, is making me seriously doubt the competence of your staff.

This is a great tactic if you want to make sure that your messages never reach the doctor. Call and be polite, but firm. Tell them that you will stay on the line until he has a free minute to speak with you. I agree that you should stress that you were told this was an emergency, but don't insult the office staff- they are probably only saying what they were told to say, and telling them that they are incompetent will get you absolutely nowhere.
posted by kro at 1:25 PM on April 13, 2011

I would make an appt for a follow-up visit with the doctor and ask all my questions then.
posted by Ochre,Hugh at 8:46 PM on April 13, 2011

As kro says, insulting the office staff will not necessarily help you. Go ahead and mention how long you've been waiting and when you've called before/who you spoke to before, but your most effective approach is still a polite one.

Do you know what hours the doctor is there? Make sure you're calling when s/he is likely to be in. If s/he is with a patient, offer to wait on hold, OR wait for him to call you back between patients. Being persistent but also flexible is good. Be willing to make an appointment--doctors may be plagued by patients who want to do everything by phone (so the patient avoids paying for the doctor's time). Obviously you are not one of these people--you might want to offer to make an appointment, to avoid being mistaken for one of them. Ask for a same-day appointment.

Try calling just before and just after the close of business (4:55 - 5:10, for example), when the doctor is likely to be finished with the last patient, but still in the office. This is a good time to offer to wait on hold.
posted by equivocator at 10:16 PM on April 13, 2011

I am not your son's doctor; I am not any kind of a doctor at all. I am a random person on the Internet who happens to have a type of congenital hemolytic anemia that first showed up in childhood as "oh, she's a little anemic". (Actually, it first showed up as jaundice at birth, but that got mis-attributed to ABO incompatibility, but whatever.)

But I thought I should drop a comment in here to say that the incomplete but weird blood test results you listed, combined with your son's age, combined with the initial presenting problem (anemia), MIGHT (as in maybe, as in remember how I am not a doctor?) be indicative of hereditary spherocytosis, which is what I have. It's the number one most common red blood cell disorder.

High platelets, high potassium, and high MCH can all be symptoms of HS or other red blood cell disorders.
Basically, my body was breaking down its own blood supply, because my red blood cells are shaped funny and my spleen, which is kind of like the blood's filter, mistook the funny-shaped young cells for old worn-out cells and therefore tried to remove all of them. (Silly overachieving spleen.)

As a result, I had high platelets, because relative to the rest of my continually broken down blood supply, there were still lots of platelets left over. Potassium levels were high both because of all the hemolysis going on and because my cell permeability was a bit wacky with respect to their ability to pump sodium and potassium the way normal cell membranes do. And other measures, like MCV (mean corpuscular volume) were off too, due to my red blood cells' deformed shape.

Luckily, in the grand scheme of things, hereditary spherocytosis is not that big of a deal. And don't let the name fool you; 25% of cases are spontaneous mutations (mine included), not actually hereditary. If your jerk of a doctor ever gets back to you, he might order an osmotic fragility test to rule out (or confirm) HS. Basically they stick some blood cells in increasingly salty water and see when it pops open (lyses). Too fragile? Probably HS.

Again, I am NOT NOT NOT a doctor. This could be barking up the wrong tree entirely. But similarly wacky bloodwork to the partial information you chose to list in your question was a part of my childhood. So I thought I should at least mention it here as a possibility since you are clearly worried about what it might mean, and whether it might be urgent.

Please update us as to whether your jerk doctor finally gets back to you or not? And if you have any questions about HS, if that's what the problem turns out to be, feel free to MeMail me anytime.
posted by Asparagirl at 2:20 AM on April 14, 2011

I should add that I have mixed feelings about posting my previous comment, as MetaFilter is rightly wary about speculative medical diagnoses over Teh Interwebs. We are not House, M.D. But after reading treehorn+bunny's previous comment about high potassium levels, I wanted to offer up another possibility that is not necessarily a scary crisis.
posted by Asparagirl at 2:45 AM on April 14, 2011

I am not a doctor, but I do work in a hospital lab advising doctors about blood test results. I saw your question yesterday, but didn't comment because there isn't enough information in there for me to be able to determine much useful. At a minumum I would need the units and the reference ranges that came with the results.

However, I want to comment on what some others have said. treehorn bunny's comments about the creatinine, BUN ration and LDH are very likely realistic. The stuff he/she said about haemolysis isn't quite correct (due to cells being broken down in the process of taking the sample rather than clotting) and haemolysis of that kind (as opposed to the kind in the body that Asparagirl is talking about should be picked up and commented on by the lab (in the UK the result wouldn't be reported, I don't know about the US).

The high platelets are out of my area of expertise, but I do know that high platelets can cause an artefactual potassium. The platelets release potassium as the blood clots in the tube. The more platelets there, the higher the potassium. However, that's only in the test tube, the potassium level in your son's blood could be normal. This can be checked by taking another blood sample into a tube with anticoagulent. Without knowing how high the potassium was, I can't say if this is likely.

The bottom line is that your doctor has all the results, units and ranges and knows your son's medical history and without that the rest of us are guessing. I hope you can speak to him soon and I would definitely consider moving practices or at the very least complaining about the way you've been treated.

One other thought, have you tried crying down the phone at them? Often surprisingly effective.
posted by *becca* at 3:54 AM on April 14, 2011