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Interpreat C/o fever since 3 days
Here is the interpretation of this CBC and CRP report for Master Yashraj Nagaraj Naik, 6 years / Male, presenting with fever for 3 days:
CBC + CRP Interpretation
Patient Details
- Age/Sex: 6 years / Male
- Date: 29-07-2026
- Complaint: Fever x 3 days
Key Findings at a Glance
| Parameter | Result | Status | Significance |
|---|---|---|---|
| Haemoglobin | 12.6 g/dL | Normal | Within age-appropriate range |
| Total WBC | 4.33 × 10³/mm³ | Normal | No leukocytosis |
| MCV | 74.6 fL | LOW | Microcytosis |
| RDW-SD | 34.0 fL | LOW | Uniform small RBCs |
| MPV | 7.3 fL | LOW | Small platelets |
| P-LCR | 6.8% | LOW | Reduced large platelet fraction |
| Neutrophils | 35.2% | LOW | Relative neutropenia |
| Lymphocytes | 48.2% | HIGH | Lymphocytosis |
| Monocytes | 13.3% | HIGH | Monocytosis |
| Platelet Count | 2.38 Lakhs/cumm | Normal | 2,38,000 - adequate |
| CRP | 2.07 mg/L | Normal | Below 6 mg/L cutoff |
Detailed Interpretation
1. CBC - Haematology
- Hb 12.6 g/dL - Normal for a 6-year-old male (ref: 11.5-14.5).
- MCV 74.6 fL (LOW) with normal Hb and normal RBC count (4.64) suggests mild microcytosis, likely early/mild iron deficiency or thalassaemia trait. This is NOT acutely related to the current fever but is a background finding worth investigating.
- RDW-CV 12.6% is normal (anisocytosis not significant), but RDW-SD 34.0 fL is low, consistent with a homogeneous population of small red cells - more suggestive of thalassaemia trait than iron deficiency (where RDW is usually elevated).
2. WBC Differential - Key Finding
- Total WBC 4.33 × 10³/mm³ is NORMAL - no leukocytosis, which argues against a typical bacterial infection.
- Neutrophils 35.2% (LOW) - relative neutropenia
- Lymphocytes 48.2% (HIGH) + Monocytes 13.3% (HIGH)
This pattern of low-normal WBC + relative lymphocytosis + monocytosis + neutropenia in a child with fever is a classic pattern seen in VIRAL infections (e.g., EBV, CMV, enteroviruses, adenovirus, dengue early phase).
3. Platelets
- Platelet count 2.38 lakhs/cumm = 2,38,000 - Normal (1.5-4.5 lakhs).
- MPV 7.3 fL (LOW) and P-LCR 6.8% (LOW) indicate small, possibly less active platelets. Monitor - in dengue fever, platelets can drop rapidly over the next 24-48 hours.
4. CRP - 2.07 mg/L (NORMAL, <6)
- CRP is not elevated, which further supports a viral aetiology over bacterial.
- Bacterial infections typically drive CRP >20-40 mg/L. A CRP of 2.07 mg/L effectively argues against significant bacterial infection at this time.
Clinical Summary
| Assessment | |
|---|---|
| Likely aetiology of fever | Viral infection (lymphocytosis + monocytosis + normal/low WBC + low CRP) |
| Background finding | Mild microcytosis (MCV 74.6) - consider thalassaemia trait or iron deficiency - needs Hb electrophoresis / serum ferritin |
| Dengue concern | Platelet count currently normal, but low MPV and clinical fever warrant dengue NS1/IgM serology given endemic area |
| Bacterial infection | Unlikely - CRP normal, no leukocytosis, no neutrophilia |
Suggested Next Steps
- Dengue NS1 antigen + IgM/IgG - fever day 3 is ideal timing for NS1
- Repeat CBC after 24-48 hrs - to watch for platelet drop (if dengue suspected)
- Peripheral blood smear - to characterise lymphocytes (atypical lymphocytes suggest EBV/CMV/viral syndrome)
- Widal test / Malaria MP/RDT - if clinically indicated based on local endemicity
- Hb electrophoresis + serum ferritin - to evaluate the low MCV once acute illness resolves
- Symptomatic management - antipyretics (paracetamol); avoid NSAIDs until dengue is ruled out
Bottom line: This is a picture consistent with an acute viral febrile illness in a 6-year-old child. The low CRP and lymphocyte-predominant differential count argue against bacterial sepsis. Dengue should be actively excluded given the 3-day fever, thrombocyte indices, and endemic region. A background microcytic picture (likely thalassaemia trait) should be evaluated after recovery.
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