Bulgarian Doctors Save Two-Month-Old Baby with 1,000,000 White Blood Cells

Through joint efforts, close collaboration and remarkable courage, doctors from the Intensive Care Unit of the Prof Ivan Mitev Children’s Hospital and the Paediatric Haematology and Oncology Clinic at Tsaritsa Yoanna – ISUL University Hospital have saved the life of a two-month-old baby with an exceptionally high white blood cell count of one million.

The child’s parents sought medical advice at the children’s hospital after their baby had lost its appetite and become increasingly lethargic over the previous ten days.

The duty paediatrician referred them for blood tests — and what followed was described by staff as “like a scene from a film”.

Faced with the shocking laboratory results, doctors requested an urgent consultation with colleagues from the paediatric oncology clinic at ISUL. On call that day was experienced specialist Dr Konstantin Băchvarov, who immediately responded.

“Even to someone without medical knowledge, 1,000,000 white blood cells — when the normal range is between 4,000 and 14,000 — sounds terrifying. For a paediatric haematologist, it signals a very, very critical condition. I’ve been a doctor for more than 30 years, but I have never seen anything like this,” said Assoc. Prof. Boryana Avramova, head of the Paediatric Haematology and Oncology Clinic at ISUL, who was notified straight away.

She recommended an immediate exchange transfusion — a procedure in which the baby’s blood is replaced with donor blood — to prevent potentially fatal complications affecting the brain and lungs.

The intervention was extremely high-risk: the infant was just two months old and weighed only four kilograms. It was, however, the only possible and urgently required treatment. Any delay would have been fatal.

A new challenge soon emerged. The junior doctors on duty that Sunday evening had no experience performing an exchange transfusion on such a critically ill baby, and understandably hesitated to take on the responsibility.

“At that moment, the director of the Prof Ivan Mitev Children’s Hospital, Dr Blagomir Zdravkov, called me and said: ‘If you explain what needs to be done, I’ll go and do it myself,’” Avramova recalled.

“I was deeply impressed by his willingness to take on a procedure for which he did not have extensive experience, and by his readiness to respond immediately — late on a Sunday night, when he was neither at work nor on call," says Assoc. Avramova.

Dr Zdravkov, together with the intensive care team and Dr Băchvarov from ISUL, undertook the complex procedure. Avramova, unable to be present, guided them by phone.

Fortunately, the team — led by Dr Zdravkov, one of Bulgaria’s most experienced paediatric intensivists — completed the exchange transfusion successfully.

In the following days, with a larger team and more time to prepare, two additional exchange transfusions were performed, reducing the white blood cell count to 300,000.

ISUL specialists then carried out a bone marrow aspiration at the children’s hospital to confirm the diagnosis — a procedure which also carries risk, as in infants it is performed from the tibia.

Additional therapy was prescribed and, encouragingly, the baby responded well. On 24 November 2025, the infant was transferred to the Paediatric Haematology and Oncology Clinic at ISUL for continued treatment. Blood tests at that point showed 60,000 white blood cells.

Despite the improvement, the condition remains highly precarious, as the excessive number of white cells suppresses normal blood formation, causing a dangerous drop in platelets — a life-threatening situation for a newborn.

For now, the child is stable and treatment is ongoing.

“I am glad that, through collective effort, we were able to stabilise the baby. I want to highlight the enormous contribution of Dr Zdravkov and commend his courage and selfless response. Few people would act with such heart — and for completely ordinary people they do not even know,” said Avramova.

photos by BGNES

Avramova noted that leukaemia in an infant this young is extremely rare and scarcely documented even in international medical literature — another testament, she said, to the expertise of Bulgarian doctors.

The case again demonstrates the urgent need for a dedicated national children’s hospital, where paediatric specialists from different fields can work under one roof.