Spotting anemia signs in your children

Dear Dr. Donya,

I have a problem. It concerns my daughter Adithi. She is two years and 10 months old. When she was one year old, she would get an ear infection on and off. By two and half years, she became prone to ear and throat infections. Despite giving her antibiotics, the infections did not go away. Following my doctor's advice, I took her to Singapore to have a grommet tube inserted and to have a tonsillectomy.

After the operation, she would get infections but they went away with antibiotics. She's getting better and is starting to eat more.

But my family has a history of blood cancer. My cousin's eight-year-old child died of blood cancer. So I had the doctor give her a blood test. Her blood test results were as follows: hemoglobin 10.7; RBC 3.5; WBC 11600; Hematocrit 32; thrombocytes 210000; Sed Rate 12; Neutrophils 60; Lymphocytes 31; Monocytes 4; Eosinofils 5; Basophils 0.

A general practitioner told me that my daughter is anemic and prescribed iron tonic for her. I want to know whether she is really anemic and if there is cause to be concerned about any other disease. Do I have to run further blood tests?

-- Mrs. D.J.

Dear Mrs. D.J.,

The World Health Organization defines anemia as follows: children between the ages of three months and four years who have hemoglobin below 11 g/dL or hematocrit below 33 percent; female adults and children who have hemoglobin less than 12 g/dL or hematocrit less than 36 percent; male adults who have hemoglobin less than 13 g/dl or hematocrit less than 39 percent; pregnant women who have hemoglobin less than 11 g/dL or hematocrit less than 33 percent.

Your daughter has hemoglobin of 10.7, which is very low. In my opinion, you should have another blood test performed on her. The causes of anemia fall into four main groups.

1. Bone marrow defect (bone marrow produces red blood cells), such as leukemia.

2. Abnormal process of red cell maturation, such as folate deficiency and iron deficiency.

3. Hemolysis process such as malaria, poison or a chemical reaction from drugs.

4. Bleeding or chronic blood loss such as bleeding in the bowels or a peptic ulcer.

If a doctor looks at the red blood cells of a patient, he or she can roughly tell the cause of anemia. For example, if it is leukemia, the blood smears on the slide will show bizarre white blood cells. If it is iron deficiency, the slide will show smaller red blood cells and paler than normal red blood cells. But a definite diagnosis would require more than just a blood smear.

From your information, you said your family has a history of blood cancer, what kind is it? Is it leukemia? If you can tell me what kind of cancer you are worried about, I can give you more specific tests or facts about the disease.

-- Dr. Donya

Dear Dr. Donya,

When my father was young, he fell and hurt his knee while playing football. He is now 70 and often complains about the pain in his knee. Usually, if he feels the pain, he applies pain relieving cream. He also said he cannot eat apples or oranges because the two fruits can cause him more pain. My questions are:

1. What does my father suffer?

2. If he has to consult a doctor, which type of doctor

should he go to?

3. Is it possible apples and oranges can increase the pain?

Looking forward to your reply.

-- Anna

Dear Anna,

I think your father may have "osteoarthritis", which is also called degenerative arthritis, degenerative joint disease or osteoarthrosis, making up about half of all kinds of arthritis.

The disease, which mostly affects adults over 45 years of age, may affect any joint in the body, including those in the fingers, hips, knees, lower back and feet. Initially, it tends to strike only one joint, especially weight-bearing joints.

The parts of your father's body that bear most of his weight -- the hips, knees and feet, are the most susceptible to osteoarthritis. As cartilage slowly deteriorates over several years, he can develop chronic pain or varying amounts of discomfort when he stands and walks. Swelling may also occur, especially in his knees.

If he has osteoarthritis, he may experience the following symptoms:

* Pain in a joint during or after use.

* Discomfort in a joint before or during a change in the weather.

* Swelling and stiffness in a joint, particularly after using it.

* Bony lumps on the middle or end joints of the fingers or the base of the thumb.

* Loss of flexibility in a joint.

A doctor may use a physical examination, blood tests and certain imaging techniques to diagnose his problem. Blood tests are used to diagnose or rule out specific types of arthritis. Fluid may also be withdrawn from a joint for analysis. X-rays, bone scans, computerized tomography (CT scan), magnetic resonance imaging (MRI) and arthrography (an image taken after dye has been injected into your joint) may be used.

Eating a healthy diet emphasizing fruits, vegetables and whole grains can help to control weight and maintain overall health, allowing the patient to deal better with arthritis. However, there is no special diet effective for treating arthritis. It has not been proven that eating any particular food will make your joint pain or inflammation better or worse.

In this case, you may take your father to see a bone specialist, orthopedist or rheumatologist.

-- Dr. Donya