<s>[INST] Hi there, My 12 yr old daughter has been unwell for a number of months with a series of symptoms. Some of these including , regular nose bleeds, sore feet that become slightly swollen, swollen eyelid, mosquito scars that have been on ankles for 12 months, pale skin, alooecia- 2 x less than 5cm, sty in her eye and mouth ulcer, and more recently extreme thigh pain - sensitive to touch and difficulty to walk as sore and fatigued. Her 3 blood test results over last 12 weeks show a decline in WCC from 5.8 - 4.2 - now 3.8L her leukocytes being 1.2L each time and Her neutrophils being 4.1 - 2.5 - now 2.0 borderline. Her Anion Gap 17H Her urea being 7.5h - 6.2 and now 5.6 Her protein in urine being .17H then .16H Her creative concentrate being 11.2 then 15.1 then 9 Her ALT being 12L - 12L - 11L Her GGT being 8 - 10 - 8 Her Ana being 1:1280 and now speckled 1:160 positive Her complement c3 .78L then .82L Her complement c4 has been .13L [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. You have done a great job in putting together important material concerning your daughter. Does she have a rash?  Does she have  photosensitivity of her skin? Is your daughter taking any drugs? From among all of the physical findings and lab data, I am going to highlight several of them: - mouth ulcer -protein in her urine -leukocytes less than 4L -ANA is present These findings together suggest the diagnosis of systemic lupus erythematosus (SLE). However, additional evaluation must be done before the diagnosis is certain. In lupus another cell type in the blood (platelets) is often low. This cell type is not listed among the blood reports. However, if her platelets are low, this could explain her nose bleeds. Platelets are necessary to stop bleeding in the body. Lupus is a very serious illness. She needs to be evaluated by a pediatric rheumatologist as soon as possible. This type of specialist can be found at a university medical center. I hope this is helpful.  Please return if we can assist you again. </s>