Q: My 4-year-old daughter has low red blood cell. It varies from 2,500 to 3,400. She has been frequently affected by fever for the past 15. Her treating doctors hasn't given any medicine to increase the RBC. What medicines should she take? What will happen to her in future and how to solve this problem?

A:I think you mean the total leukocyte count (TLC) and NOT RBC count in your query. The Hb, red cell indices and TLC varies with age and sex of the individual. The normal TLC for a child 2-6 years old is 5,000 - 15,000/mm3 and the RBC count 4.0 - 5.2 million/mm3. She is having low white cell count referred to as leukopenia. It is important to know the differential count i.e. the percentage of various white blood cells as that is a better indicator. The absolute neutrophil count (ANC) should normally be 1,500 - 8,000/mm3 and the absolute lymphocyte count 6,000 - 9,000/mm3. The severity of neutropenia is categorized as mild with an ANC of 1000 - 1500 cells per mm3, moderate with an ANC of 500 - 1000 cells per mm3, and severe with an ANC of fewer than 500 cells per mm3. The risk of bacterial infection is related to the severity and duration of neutropenia. A large number of infections (bacteria, viruses etc) and drugs can cause a reduction in the TLC. Care is mostly supportive and based on the cause, severity, and duration of neutropenia. Your doctor would be best placed to examine and evaluate her. In case of prolonged neutropenia or fever he/she will give appropriate antibiotics after culture of the throat swab, blood, urine etc. and growth factors to stimulate WBC production, if indicated.