persistent fever

My six-year-old son has been suffering from fever for the last one month. A course of antibiotics has failed to cure him. In addition, he's recently developed gum bleeding. What's the problem'

It seems your child is suffering from some blood disorder. First of all, he should be assessed clinically, and then a complete haemo-gram (a test to know the levels of blood haemoglobin, and blood cells like platelet, red cells and white cells and so on) should be done. The results of the report will decide if he needs bone marrow examination. The clinical history indicates a case of leukae-mia. If the tests confirm it, another bone marrow exam will be needed to find out the type of the disease based on the structure, chemical nature and immunological properties. Treatment should be planned after all the tests.

severe anaemia

My six-month-old daughter has been more or less healthy since birth. But for the last couple of months she has been very lethargic. She looks pale all over the body and her abdomen has swelled into a hard mass. We are worried. What has happened to her'

The history suggests that your child has severe anaemia with an enlarged spleen. Since she is just six months old, it seems to be a specific variety of the ailment called chronic haemolytic anaemia. However, there may be other disorders. It's essential that your daughter undergoes a thorough clinical assessment. I suggest you go for a haemogram. Apart from that, an investigation called 'haemoglobin electrophoresis' may be needed for both the child and the mother. If the test confirms thalassaemia, treatment should be planned accordingly. In case of beta thalassaemia (a variant of the disease) regular blood transfusion should be done with iron chelation therapy, done with a drug called desferoxamine, regularly at three to four weeks' intervals. As the child grows older, more specific therapy like bone-marrow transplant(BMT) should also be considered.

complex anaemia

My wife (22) is four months pregnant. It's her first pregnancy. But she has had anaemia characterised by breathlessness, weakness and pale body surface, with haemoglobin at a low level (8 gm/dl). Our doctor prescribed iron tablets for her problems. She took them for some time. But they were of no use. What course of action should we follow' I think she is a carrier of thalassaemia which is not that problematic (except to a mild to moderate degree). This is why iron tablets aren't helping her. Please get in touch with a haematologist for a thorough clinical examination. She also needs a few diagnostic tests. If tests indicate that she's a carrier of thalassaemia, you should also get yourself screened for thalassaemia ' to assess the result of the outcome of your wife's pregnancy. However, if investigations rule out thalassaemia, other causes of anaemia (those which don't respond to iron treatment) should be explored and treatment should be done accordingly.

blood transfusion

My five-year-old daughter has been suffering from thalassaemia. She needs regular blood transfusion. But it's so expensive that we can't afford it. Can you suggest any alternative remedy'

Although blood transfusion is always preferred in thalassaemia major, in some cases we suggest surgical removal of the spleen 'an organ in our abdomen to help the defence mechanism of the body. This helps cut down the frequency of blood tranfusion. The operation is a tricky one, and proper precaution should be taken after the surgery. However, after the removal of the spleen, your daughter will have to stay at a higher risk of several infections as her immune status would be compromised following the operation. These are the reasons why not many patients are advised this line of treatment. Apart from the removal of the spleen, consumption of wheat grass juice and some other medicines (such as L carnitine) can also help cut down the frequency of blood transfusion.