Children being treated for cancer experience wildly fluctuating blood counts. White cells can range from zero to higher than normal, whilst red cell and platelet counts may drop periodi cally during treatment, requiring packed red cell and/or platelet transfusions. The absolute neutrophil count (ANC) should be closely monitored as it will give an idea of your child's ability to fight infec tions. ANC can range from zero to figures in the thousands. All of your child’s blood values will be important in painting a picture of how she is likely to respond to her illness, its treatment, and possible infection. Her individual patterns will be far more significant than any sole value. For example, if the values of three tests are 5.0, 4.7 and 4.9, the second result is not important. However, values or 5.0, 4.7 and 4.2 demonstrate a decrease in the cell line. Therefore, it is important that you know your child’s regular blood values and patterns. Many parents experience great confusion and concern over the importance of their child’s brittle blood counts, especially in the early days after cancer diagnosis. These changes may require transfusion of blood products, changes to chemotherapy dosage, or limitation of visitors to prevent infection exposure. It is important that you always discuss your concerns to prevent them from escalating. The following sections explain each of the blood values shown in the table above. Oxygen and carbon dioxide are carried through the blood by molecules within the red blood cells called haemoglobin,. Low haemoglobin is also called anaemia, symptoms of which include fatigue, pallor and shortness of breath. As cancer and chemotherapy both decrease the bone marrow's ability to produce new red cells, low haemoglobin may be a characteristic of diagnosis and may be caused by intensive treatment. Your child’s haemoglobin levels will give an accurate picture of her blood’s ability to carry oxygen. Haematocrit represents the percentage of red cells in the blood. To determine the ratio of plasma (clear liquid part of blood) to red cells, a blood sample is spun in a centrifuge to separate the two products. If your child has a Haematocrit of 25%, it means that her test produced 25% blood cells and 75% plasma. During chemotherapy, your child’s bone marrow will not manufacture many red cells, so her Haematocrit will decrease. This means she will have less oxygen in her blood, and her energy levels may become low. She may be given a transfusion of packed red cells if her Haematocrit drops below 20%. In healthy individuals, the bone marrow continually manufactures red blood cells which, as we have already discussed, transport the oxygen and carbon diox ide rich haemoglobin molecules throughout the blood stream. An automated electronic device is used to count the number of red cells per litre of blood. The following three red cell indices of MCHC, MCV and MCH, are mathematical relationships of Haematocrit to haemoglobin, Haematocrit to red cell count and haemoglobin to red cell count. These are numerical expressions of the level of change identified in red cells, and the concentration of haemoglobin present within each cell. Low teens are acceptable figures, but a distorted red cell population is represented by raised indices. White blood cells make up the body's natural defence against infection. As cancer treatment destroys white cells, you will need to be prepared for periods of low immunity, during which your child will be highly susceptible to serious illness. You will need to take extra precautions during these times, to protect her from infection exposure. An automated electronic device counts the number of white cells per litre of blood. If your lab report shows your child’s WBC as K/UL instead of MM3, multiply by 1000 to get the value in mm3. For example, if the total WBC is 0.6 K/UL, use the calculation 0.6x1000 = 600 mm3. A Complete Blood Count (CBC), will state the total white blood cell (WBC) count and a "differential". This differential breaks down each type of white blood cell, listing them as a percentage of the total. For exam ple, if the total WBC count is 1500 mm3, the differential might appear as in the fol lowing table: |
| Blood Values for Healthy Children. |
| "Do not go where the path may lead, go instead where there is no path - and leave a trail." ~ Ralph Waldo Emerson ~ |
| ORPHANS OF THE CANCER STORM |
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| When your child is diagnosed with cancer and begins treatment, keeping track of her blood counts will become a way of life. Inadequate explanation about the different blood values can cause confusion and worry for parents. This page attempts to address these issues by explaining the meaning of different blood values, identifying the average blood counts for healthy children, and the expected impact of cancer therapy on a child's counts. This information should enable you to better understand your child’s blood count reports, and thus identify changes in her values. Blood Values for Healthy Children Values for children on chemotherapy What do the different blood values mean? Blood values and your child. |
| Disclaimer This information page has been prepared by an individual who does not have medical training. However its contents have been reviewed by appropriately qualified medical professionals for accuracy and quality. This page is intended for information purposes only and should not be used as a guide to diagnosis or treatment. If this information raises any concerns about your child’s condition or care protocol, discuss them with his or her paediatrician, oncologist, or other appropriate medical professional who has knowledge of the case. |
Every laboratory has a reference handbook detailing optimal values for each blood cell. These manuals vary between laboratories, and the figures given here are for guide purposes only. The age of a child is a factor in her blood values. For example, infants and toddlers will have lower granulocytes and higher lymphocytes than the figures indicated below. Reference ranges may also be influenced by geographic location. |
| During recovery from low blood counts, metamyelocytes, myelocytes, promyelocytes, and myeloblasts may also be found in the blood, and may therefore by listed in lab reports. These immature white cells are usually only found in the bone marrow. Absolute Neutrophil Count (also known as the Absolute Granulocyte Count or AGC) is a determination of your child’s ability to fight infection. A child with an ANC greater than 1000 is generally considered to have near normal infection fighting capacity. If your child’s ANC drops below 1000, she becomes neutropenic, meaning that her body is not adequately able to fight infection. Severe neutropenia is characterised by an ANC of less than 500, and this can lead to life threatening infections. Prolonged periods of neutropenia or a dramatic drop in counts may indicate a sepsis. Calculating your child’s ANC is relatively easy. Simply add the percentages of both segmented and band neutrophils, then divide that percentage figure by 100 and multiply by the total WBC. See example below: Segmented neutrophils = 49% Band neutrophils = 1% White Blood Count = 1500. 49% + 1% = 50%. 50 / 100 = 0.5 x 1,500 = 750 The ANC is 750. Platelets help repair wounds and prevent bleeding by forming clots. In analysis, they are counted by an electronic device. As they travel through the body, approximately one third of all platelets can be found in the spleen at any given time. Dysfunction of the spleen will therefore impact platelet counts. For example, enlargement of the spleen may cause a precipitous drop in counts, whilst its removal may result in a dramatically elevated platelet count. A raised platelet count is known as thrombocytosis. As chemotherapy depresses bone marrow function, the production of platelet counts will also decrease. Low platelet count is referred to as thrombocytopenia. Bruising, bleeding gums and nose bleeds are symptoms of decreased platelet levels. If significant bleeding occurs, or your child’s count is very low, a transfusion may be given. This test assesses liver function, and the organ‘s response to chemotherapy. If your child's liver is not coping with the toxic effects of chemotherapy drugs, an enzyme called ALT will be released into the blood serum by damaged liver cells. During chemotherapy, your child’s ALT levels may rise into triple figures. Some children even experience ALT elevated into the thousands. Your child’s hospital will have its own protocol for decreasing or temporarily ceasing her chemotherapy treatments in order for her liver to recover. If you notice a change in your child’s ALT levels, discuss them and their implications for treatment with her doctor. AST is a highly concentrated enzyme found in the liver. When liver tissue is severely damaged, its cells discharge AST into the blood serum, and so the level of AST present in the blood directly represents the extent of tissue damage. During chemotherapy, your child’s AST levels may rise into the thousands if her liver is suffering toxic effects of treatment. Viral infection and reaction to anaesthetic are among the many other possible explanations for raised levels of AST. Ask your child’s doctor for an explanation if you notice a significant unexpected increase in her AST blood levels. When red blood cells are damaged, haemoglobin is released and converted into bilirubin. Removal of bilirubin from the blood is carried out by the liver, which then expels it into the bile, from where it is transferred to the small intestine to aid digestion. Ordinarily, bilirubin occurs in the bloodstream only in small amounts, but your child’s levels will rise if an excessive volume of red blood cells is being destroyed, or if liver damage is preventing normal excretion. The two types of bilirubin, indirect (unconjugated) and direct (conjugated), indicate the source of raised levels. Increased indirect bilirubin is present when red cells are being destroyed in excess. Increased direct bilirubin is observed when the liver is blocked or dysfunctioning. Jaundice (characterised by the yellow skin colour) occurs when bilirubin seeps into the tissues due to excess blood levels. Ask your child’s doctor to explain the situation if her total bilirubin levels increase above her normal levels. Urea nitrogen is an end product of protein metabolism. The BUN test is used to assess kidney function, and identify a host of disorders, including liver disease, dehydration and shock. Elevated blood urea nitrogen levels are frequently seen with kidney or liver disease. Found in the blood and urine, creatinine is a by-product of protein metabolism. Levels are tested to assess kidney function and to identify the presence and extent of possible kidney disease. Creatinine Clearance Tests are used to assess kidney function, in particular their efficiency of creatinine filtration and excretion. Insufficient kidney function and renal failure frequently result in elevated creatinine levels. Your child is completely unique, and even though she may be receiving the same protocol as another child with the same tumour, her response to treatment will be highly individual, and likewise, she will develop her own pattern of blood counts. Continually observant parents are able to help keep track of these patterns and identify any significant changes. If you notice a change in your child’s pattern, or you are concerned about certain levels, discuss them with the doctor. All blood test results will be considered by your child’s medical team in order to gain an overall picture of her condition before a decision can be made on how to proceed with treatment. Ask for an explanation of the situation the potential plan of action. This will enable you to better understand what is happening to your child, thus reducing your concerns and stress levels. If your child is participating in a Clinical Trial, consult the complete CT protocol to determine what actions should be taken by her doctors in response to specific blood count changes. You should be able to obtain a copy of the clinical trial protocol, or access it at your child’s hospital. Go back to CHEMOTHERAPY main page. Go back to GENERAL TREATMENT index. Go back to ORbIT TREATMENT index. Go back to SONGS TREATMENT index. |
| BLOOD COUNT TYPE |
| Haemoglobin (Hgb). |
| Bilirubin (total) Direct (conjugated) Indirect (unconjugated) |
| Haematocrit |
| Red Blood Count |
| Platelets |
| White blood count |
| WBC differential Segmented neutrophils Band neutrophils Basophils Eosinophils Lymphocytes Monocytes |
| Alanine aminotransferase (ALT) |
| Aspartate aminotransferase (AST) |
| Blood urea nitrogen (BUN) |
| Createnine |
| BLOOD COUNT TYPE |
| 0.3-1.3 mg/ud. 0.1-0.4 mg/ud. 0.2-0.18 mg/ud. |
| 34-40% |
| 3.95-5.3m/cm or 3.95-5.3 X 1012/L |
| 160,000-500,000 mm3 |
| 5,000 - 10,000 mm3 or 5-10K/ul. |
50-70% 1-3% 0.5-1% 1-4% 12-48% 2-10% |
| 0-36 IU/L. |
| 0-48 IU/L. |
| 10-20 mg/dl. |
| 0.3-1.1 mg/dl. |
| 11.5-13.5 g/100ml. |
| White Blood Cell Differential |
| BLOOD COUNT TYPE |
| Segmented neutrophils (also called polys or segs) |
| % OF TOTAL WBC |
| Band neutrophils (also called bands) |
| Basophils (also called basos) |
| Eosinophils (also called eos) |
| Lymphocytes (also called lymphs) |
| Monocyles (also called monos) |
| 49% |
| 1% |
| 1% |
| 1% |
| 38% |
| 10% |