Re: [Re: ] Flu?

[Guest guest]

In a message dated 2/24/2005 12:04:18 AM Eastern Standard Time,

bunneegirl@... writes:

My MIL found a totally non-dairy yogurt at Whole Foods Markets, it's pretty

good so now I have a good way to get probiotics in Em without aggravating

her

dairy/GERD issues and hopefully preventing another painful vaginal yeast

infection due to being on abx. Little Kate's dairy issues are worse so she's

never

tasted yogurt in her life, she's LOVING this stuff!!

That is wonderful!! I sure hope it helps her. Let her eat away. =)

Janet, Mom to Brittany, CVID, age 14

[Guest guest]

" CBC showed WBC only 8,000 but left shift, so they started her on Augmentin just

in case and will re-do counts tomorrow. "

My daughter had similar symptoms last month. Can you explain left shift and how

to tell the difference between viral and bacterial infections -- when is

feeling better. Thanks.

(mom to la, low everything and feeling better).

bunneegirl@... wrote:

has some rotten bug and I feel sure it's the dreaded influenza. Sent

her to school yesterday knowing she sounded like she had a new cold, but she had

no trace of fever. Wasn't at school more than 15 min. when fever hit and

nurse called to come get her. She was weak and looked awful and I felt a little

sheepish, like the guilty mom who sent a really sick kid to school, but she

really wasn't that sick before!!!

She was coughing, had a headache and her fever was 101 under the arm -- she

stayed on the couch all day. Tylenol only took fever down one degree and though

she had no energy she did not seem lethargic, color was good.

Today 101 oral and baaaaad body aches. Same headache, cough, etc. Flushed

cheeks from the fever I guess. Throat looked okay, lungs sounded fine, ears came

up okay with " Ear Check " device. Her left eye is red but no goop. Called ped

thinking flu for sure, they said with that fever to bring her in to check for

flu.

Nasal swab came back negative. But I'm thinking, it looks like flu, feels

like flu... ya know? Maybe it's a different strain than what they test for. They

said they are seeing alot of this, fever, body aches, seems like flu but tests

negative. Doc seemed confused by that but I looked up the tests and they

certainly are not 100%.

Anyway, they did a finger stick just in case (she also had some naaasty

bruising under the skin on her foot, it looked somewhat like purpura but had

been

there a day before the fever so I wasn't too worried about it but when I showed

it to the doc her eyes got real big and she whipped Em's shirt up looking for

more. I didn't tell the doc but I had already done that! (bug-eyes and all!)

Anyway, if this is the flu (regardless of swab results!), by tomorrow it's

pretty much too late to start Tamiflu or similar... I didn't think of that until

tonight. Sigh.

CBC showed WBC only 8,000 but left shift, so they started her on Augmentin

just in case and will re-do counts tomorrow. I bet you a million dollars the WBC

will be 5,500 or lower tomorrow and no more left shift. We'll see -- I've

seen this pattern before!

My MIL found a totally non-dairy yogurt at Whole Foods Markets, it's pretty

good so now I have a good way to get probiotics in Em without aggravating her

dairy/GERD issues and hopefully preventing another painful vaginal yeast

infection due to being on abx. Little Kate's dairy issues are worse so she's

never

tasted yogurt in her life, she's LOVING this stuff!!

(mom to , age 6, dairy intolerant-related GERD -- currently has

polysaccharide antibody def, previously had transient IgG, IgA, t-cell & other

defs... and also to Kate, age 2, more dairy intolerant but very healthy!)

[Guest guest]

:

The term " left shift " or " shift to the left " comes from back when they used

to do the differential by hand. What it means is that there is a high

percentage of neutrophils (segs) and increased bands, which suggests a bacterial

infection.

Band cells are immature neutrophils, so when there is an increased number of

them it indicates that the bone marrow is working like the dickens to pump out

new neutrophils in the setting of an acute infection.

It is possible to see a left shift early in a viral infection, it's not a

perfect indicator. But when you see a high WBC (white blood cell count) AND a

left shift, it is pretty certain to be a nasty bacterial infection. That is, IF

your child mounts a normal white cell response which not all PID pumpkins do.

We're very lucky that 's counts are always reliable. So for her, if she

has a high white cell count and a left shift, we give Rocephin and try to find

the infection, doing blood cultures if necessary. Put it this way... any time

's had a high white count and a left shift it was not a false alarm. She

has, however, had normal white counts with a left shift where the left shift

settled down after a day -- in that case it was always a virus.

I don't know if everybody does this, but any time has a left shift, her

lymphocytes are also low.

If her white count is normal, I don't worry too much even with a left shift,

but we watch her and the ped we saw this time gave Augmentin because of the

left shift. I probably would have voted not to, but it wasn't my call. I'm going

by her behavior, she's not acting or looking toxic.

If 's white count is low (for her, especially if it is 5500 or lower),

we know it's a virus. This is just though, keep that in mind.

So the short version is " left shift " means high neutrophils and/or increased

bands, and it's evidence there may be a bacterial infection.

(mom to , age 6, dairy intolerant-related GERD -- currently has

polysaccharide antibody def, previously had transient IgG, IgA, t-cell & other

defs... and also to Kate, age 2, more dairy intolerant but very healthy!)

[Guest guest]

:

The term " left shift " or " shift to the left " comes from back when they used

to do the differential by hand. What it means is that there is a high

percentage of neutrophils (segs) and increased bands, which suggests a bacterial

infection.

Band cells are immature neutrophils, so when there is an increased number of

them it indicates that the bone marrow is working like the dickens to pump out

new neutrophils in the setting of an acute infection.

It is possible to see a left shift early in a viral infection, it's not a

perfect indicator. But when you see a high WBC (white blood cell count) AND a

left shift, it is pretty certain to be a nasty bacterial infection. That is, IF

your child mounts a normal white cell response which not all PID pumpkins do.

We're very lucky that 's counts are always reliable. So for her, if she

has a high white cell count and a left shift, we give Rocephin and try to find

the infection, doing blood cultures if necessary. Put it this way... any time

's had a high white count and a left shift it was not a false alarm. She

has, however, had normal white counts with a left shift where the left shift

settled down after a day -- in that case it was always a virus.

I don't know if everybody does this, but any time has a left shift, her

lymphocytes are also low.

If her white count is normal, I don't worry too much even with a left shift,

but we watch her and the ped we saw this time gave Augmentin because of the

left shift. I probably would have voted not to, but it wasn't my call. I'm going

by her behavior, she's not acting or looking toxic.

If 's white count is low (for her, especially if it is 5500 or lower),

we know it's a virus. This is just though, keep that in mind.

So the short version is " left shift " means high neutrophils and/or increased

bands, and it's evidence there may be a bacterial infection.

(mom to , age 6, dairy intolerant-related GERD -- currently has

polysaccharide antibody def, previously had transient IgG, IgA, t-cell & other

defs... and also to Kate, age 2, more dairy intolerant but very healthy!)

[Guest guest]

Thanks, . You have educated me and inspired some more questions. = ) Can

you, or anyone that has experience with this, help me work through what happened

to my daughter last month? I really want to understand how to monitor her

infections more appropriately -- based on what you said. This is particularly

important b/c she does not tolerate antibiotics. Can you tell me how you would

have interpreted my daughter's labs from last week? Thanks so much.

______

You said, " the term left shift or shift to the left comes from back when they

used to do the differential by hand...high percentage of neutrophils (segs) and

increased bands, which suggests a bacterial infection " .

So, last month, my daughter had 104.7 degree fever while on tylenol. Blood was

drawn and this is what was found:

Seg: 57% (21-41%)

Bands: 6% (5-12%)

If her segs increased and not bands, what does this mean? Could her bands be

normal because she had a virus or could her bands be normal because her body has

trouble producing neutrophils? She generally runs low. Does this look viral or

bacterial to you? Perhaps more info would help.

WBC: 4.11 (5.0-17)

Her WBC was low. But, she usually runs < 4.0 unless she has an infection and

even then, it never goes above 7.0. It is so difficult to interpret these

things.

You said that, " I don't know if everybody does this, but any time has a

left shift, her lymphocytes are also low. "

% lymphocyte: 31% (51-71%)

I don't have the absolute count but she always runs low -- but usually at least

in the 40%s. So, perhaps 31% is low even for her.

My daughter's peds doc wanted to start IV antibiotic. But, by morning, her

fever broke and our immuno saw her. He said it would be okay to watch and wait.

It took about 3 weeks of being homebound and taking it easy, but she got through

it without antibiotics -- gave her earlier IVIG and nursing as usual. So, it

probably was a virus after all -- just maybe.

, mom to la (low everything and doing much better)

//messages

[Guest guest]

Oh, , I feel for you. It's hard enough to try to interpret the results

of the labs, but if la runs low or off on a GOOD, day, it's that much

harder to interpret, right?

For , I usually let the white count make the decision for ME on how

worried to be. But I let the docs do what they think is right, because I trust

them and they have seen thousands of lab results. So when 's WBC count was

normal last week, I didn't worry inside, even though the doc wanted her on abx

due to increased bands. And like I said before, 's WBC can drop to

anywhere from 2500 to 5500 with a nasty virus. But we're lucky that has

always mounted a predictable WBC response to bad bacterial infections

(19,000-26,000).

But if la doesn't mount a normal white cell response to infection, it

is really tricky. One thing that helps is how they look and act. I didn't

recognize it when was deathly ill the first two times as an infant, but

later

on I was able to recognize when she was very ill based on her color and how

her eyes looked. For example, once when she was around 1-1/2 yrs old, she

looked pale and only a little listless (but not lethargic yet), and her eyes

looked

*dull* and lifeless. Sort of grey lids. No fever! And she's reliable with

fevers. But Mommy's Instinct demanded I take her in, the ped trusted me and drew

blood and here she had a high white count and extreme left shift. {{shrug}}

So I think over time you have to collect a series of clues on how la

reacts with different infections? I mean, it takes awhile and many CBCs before

you can see a pattern emerging (well and sick). And even if you have all the

bloodwork, it's not perfect, I mean had a " left shift " last week and I'm

100% certain it was viral, just the very beginning stages.

Anyway, with this last virus, with the high fevers and all, both my girls

looked rosy cheeked. So that was a good sign and the ped kept commenting that

did not look " toxic " .

It's hard though, I mean Kate (non-PID) felt sooooo sick with the high fever

(and who wouldn't?) and you're worried, then when the fever comes down with

meds she's running around naked, dancing. So in hindsight I probably shouldn't

have bothered with the ER, but if I was I wouldn't second-guess it,

there's too much at stake.

Anyway, about the neutrophils. I read on a med student message board that

some docs consider it a left shift if the neutrophils are over 80%. As far as

the

segs, or mature neutrophils, I wouldn't say I could tell whether it was viral

or bacterial, but I do know you have sort of a stockpile of mature

neutrophils (segs) just sitting around and they can be released into the

bloodstream

during infection or even stress, even the stress of a traumatic blood draw? I

don't know HOW many, though, if it's a huge # that would greatly affect the

results.

Please don't take my words to be good medical advice, though, I'm no doc! And

I always have trusted 's peds -- they haven't let us down yet. You

really have to have docs you trust, that's the key. If you feel confident in

their

care, then you know you're already doing as much as you can.

(mom to , age 6, dairy intolerant-related GERD -- currently has

polysaccharide antibody def, previously had transient IgG, IgA, t-cell & other

defs... and also to Kate, age 2, more dairy intolerant but very healthy!)