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Low White Blood Cell Count

Hi -
My 7yr old son just had his 2nd Remicade infusion today. On the drive home, we got a call from the nurses saying he's anemic again, and his WBC is a little low - 3.3. They said they will check it at his next infusion in 4 weeks.
I looked at his count 2 weeks ago, and it was 7.5. Now 3.3.
I'm wondering how low is too low?
Also, is 4 weeks too long to wait to check a WBC when it already dipped that much in 2 weeks?
He's on combo therapy with Imuran. Just wondering if this is going to be too much for him? How quickly can leukemia pop up?
So much going thru my mind right now. Just wondering if anyone else has any experience with low white count and what happened.
My daughter's WBC are frequently low. The doctors don't worry too much unless Neutrophils are under 1000. Hers are checked every 4 weeks at infusions.
Thanks DanceMom - I"ll look for the Neutrophil count when they post the bloodwork. They literally called as we were driving home, and didn't mention any other numbers and I didn't know what to ask about. I"ll be sure to take a look!


Staff member
How long has he been on Imuran? Imuran can drop the WBC, and if it's a new med, I wonder if that's the problem.

If you are very uncomfortable about waiting another 4 weeks to check it, you could ask your GI or pediatrician to do blood work earlier.

Kids' numbers do go up and down sometimes. We have had a low WBC and when we re-checked two weeks later, it was in the normal range. Same with liver enzymes - were quite high, rechecked in a couple weeks and they were back to normal.

Hopefully it is just a blip and his WBC will be normal next time.

my little penguin

Staff member
Second the if imuran is new than I would ask if they could check it sooner
Ds has had them low or high depending on if he had an infection (like a cold earlier etc..)
Grace's ran low for about 2 years on Imran. Hers were between 1.8 to 3.5.
However all other levels were normal"ish".


Well-known member
Yep, an immunosuppressant's job is suppress the immune system so lower WBC's are the result and the drug is the suspect more often than leukemia.

Both my girls dip into the 3's on occasion. We usually just check at next infusion. Then if it is still low, two weeks, still low, one week. Recently we rechecked in a week and she went from 3.4 to 7.1.

Good luck! I hope they come right back up.
He's been on the Imuran since January with no negative effects besides occasional anemia. I finally got back all of his results, and his ANC is 1.8. 2 weeks ago it was 5.5. Also - there was something new that they haven't tested before - WBC morphology. This said Reactive Lymphs present. I can't figure out if this is good or bad. Also, they draw his blood before each infusion and then start the infusion right away. They don't get the results until it's over. If he's so low on these levels, don't they want to know before they give the drug again??

my little penguin

Staff member
Bloodwork bounces around a lot outside of normal limits
Those normal limits are for healthy kids on no meds with no diseases and nothing else going on to alert doctors to watch closer
Doctors have a lot of experience watching closely and know when things need to be watched and when action needs to happen
We have had "reactive lymphocytes " show up more than a few times
It hard not to worry
But you have limits above and below normal that are still ok
Ds liver numbers were "high" more than a few times due to abx but only extremely high more than three times the upper "high" limit that got him a quick "don't take anymore 6-mp "
call right away
Ds had his blood drawn daily while inpatient and it was all over the map for something