Toxic Granulation

[Mallory's Mum]

Quick question for you guys since you are so knowledgeable. We are inpatient right (IV steriods) now with the possibility of leaving tomorrrow. They ran bloodwork this morning to check numbers. Her blood work came back a little more weird than normal and I was just looking for some insight.

WBC: 13.3 (4/30) 15.6 (5/1) 23.5 (Today) 4.5-13.5 normal
Platlets: 789 (4/30) 723 (5/1) 750 (Today) 135-466k/mcl normal
SEGS: 90 (4/30) 78 (5/1) 96 (Today) 40-59% normal
ANC: 11.97 (4/30) 12.14 (5/1) 22.49 (Today) 1.5-8k/mcl normal
Hypocrome: 1+ (5/1) 1+ (today)
Microcytes: 1+ (5/1) 1+ (today)
Ovalcytes: 1+ (5/1) 1+ (today)
Plates Giant: 1 (today)
RBC Crenated: 1+ (today)
Teardrops: 1+ (today)

There was an additional note that said on today's bloodwork differential:
WBC: Mild Toxic Granulation (Moderate Granulation)

Just wondering if anyone has any insight on this. Looking for some info before morning rounds so I know what questions to ask. From what I saw on the internet, they made it seem taht toxic granulation is sepsis, bacterial infection, and on some articles intraabdominal abcesses caused by imuran with no other symptoms other than blood work. Guess the word toxic has me running. She is also on 6mp now for 6 weeks with an increased dose last week if that helps. The 4 days of 40 mg iv steriods seems to slightly help with belly aches but has not helped with appetite. She has never been below 15 mg oral and was on 30-40 2 weeks prior to admit. Her tenesmus has been alleviated by the steriod enemas though. I keep telling them that she isn't your text book crohnie and her numbers were what showed severe disease before symptoms.

Thanks a million.

 

[DustyKat]

I am not overly familiar with the term toxic granulation. I imagine it is a term they would also use here but I have not seen in relation to my children.

The results essentially suggest exactly what you have found yourself. It all points to inflammation and infection. I would think with a white cell count that high they would be looking for a infection somewhere, perhaps an abscess?
IIRC she has ileal involvement? If so that may be the place to start as disease in that area is renowned for the complications of fistulas and abscesses.

IV steroids did nothing for my son's appetite either except when he was on his third round. in a about a 5 week period.

Sorry I'm not much help but it may be a starting point.

Dusty. xxx

 

[izzi'smom]

I am no help, but hoping the IV steroids are helping and that you are able to go home tomorrow as expected!

 

[Farmwife]

Hi, you got me interested in what it was. The best and happily the most simple explanation is at http://en.wikipedia.org/wiki/Toxic_granulation

:soledance:Farmwife