Q&A – Irina A Question

Dear doctor! I am writing to you with the following question:

My son, 16 years old, had an elevated platelet count of 356.9 during a general blood test. At that time, he was being treated by a gastroenterologist. The Anaemia diagnosis was acute gastritis + biliary dyskinesia. After the full treatment, his general condition improved. A control Complete blood test was performed a month after the treatment. However, a repeat CBC blood test shows that the platelet count is 377. Other indicators:

  • hematocrit – 45.1%
  • haemoglobin – 15.3 g / dl
  • erythrocytes – 5.33 million / μl
  • MCV (average erythrocyte volume) – 84.6 fl
  • RDW (erythrocyte distribution width) – 12.4 %
  • MCH (average Hb content in erythrocytes) – 28.7 pg
  • MCHC (average Hb concentration in erythrocytes) – 33.9 g / dl
  • platelets – 377 thousand / μl
  • leukocytes – 9.88 thousand / μl
  • neutrophils (total number) – 53.5%
  • lymphocytes – 36.3%
  • monocytes – 8.5%
  • eosinophils – 1.4%
  • basophils – 0.3%
  • ESR (according to Westergren) – 2 mm / h.

Which doctor should I see now? What other tests do I need to take?

Answer:

Dear Irina, we have looked over your problem. We want to inform you that these CBC General blood test results (namely platelets) are a variant of the age norm (a platelet level of 600 thousand or more is considered reliably changed). Of the additional examination methods, we recommend a full ultrasound of the abdominal cavity and observation by a therapist, who will give you a detailed conclusion on the complete examination methods and, if necessary, refer you to a haematologist.

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Question

What type of anaemia?

Hi, I’ve had consistent labs over 10 years that show me as having high RBC and low MCV/MCH. My iron levels, B12, and thyroid panels are all normal. I’m a female in my late 40s, post-hysterectomy. However, like all the rest, here’s a screenshot of my latest CBC labs.

My energy levels are in the dumps. I have low exercise tolerance, sweat excessively, have anxiety, and am prone to feeling dizzy/faint. I’ve raised my concerns with several docs but can’t get anyone to give a diagnosis. I’m told my labs are normal. My family doc does not think I should follow up on this and was not interested in referring me to hematology.

Should I self-refer to haematology? Also, I want a diagnosis and, hopefully, some form of treatment. What do you all think?

Answer:

There’s nothing here that we can tell you. These CBC labs say that your blood cells have less haemoglobin and trouble delivering oxygen, which would match your dizziness symptoms.

You said your iron and thyroid panels are normal, so you don’t have blood anaemia. However, you can only diagnose anaemia from the abnormal labs you do get.

If you wanted to, you could get a blood oxygen pulsimeter—the little device the nurse puts on your finger—and watch your blood O2 levels. However, this doesn’t tell you anything and doesn’t really help your doctor. You will most likely find that your O2 saturations are lower than optimal. Still, some people live their entire lives with O2 saturations lower than normal, and it’s not necessarily a health issue.

It could be that your stress levels are very high, so you are excessively sweating.

Your next step would be to ask your doctor for a complete vitamin panel. This is not a fasting test, but it’s better if you do fast because you can’t self-medicate and not realise that you’ve skewed your numbers. Some of these symptoms could be a B12 deficiency. Still, this usually presents with some other CBC issues symptoms, and you have a weird set of symptoms – you’re missing the main symptoms that I expect to see for a vitamin deficiency.

Is it possible that you are fighting off some sickness? How long have you felt this way?

( not a doctor or clinician, just a normal internet person)

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Question

Low ferritin but normal haemoglobin?

I have been dealing with debilitating fatigue, muscle pain and brain fog for years now. My GP has regularly brushed me off because my bloodwork is normal. And at a recent check-up, I asked for my bloodwork to be redone bc of the above symptoms and was told I was fine and my fatigue was caused by “thinking too much” 😮😮 Being gaslit by my GP has been an awful experience, and I left me feeling upset.

I got a copy of my CBC bloodwork, and it says that my haemoglobin is normal (134), but my ferritin is 12. Is it possible that this would account for my symptoms? I have extremely heavy periods every month and have suffered from this for the last six years after I had my third child. I’ve had numerous internal ultrasounds, but nothing has ever been found. My GP says it’s impossible to have symptoms of fatigue with normal haemoglobin, even if my ferritin is low. Would appreciate some insight.

Answer:

Please see a haematologist! I was brushed off for years because my CBC was normal, too. Chest pain, joint pain, fatigue, brain fog. They wanted to check for asthma, RA… anything else but iron deficiency.

A gynaecologist finally listened to my complaints of heavy menstrual bleeding & agreed to run an iron panel and ferritin (4) per my request, which showed my body was in severe distress. She referred me to a haematologist and asked me to take oral iron supplements. Eight weeks later, when I finally met with the haematologist, my ferritin was 12. We checked again in 4 weeks because the gyn is still trying to help figure out how to stop the bleeding. My ferritin was still stuck at 12 because I was losing any progress/added benefit from the supplements. The haematologist ordered iron infusions, and I just finished my 2nd round of Feraheme today. I can’t believe how much better I feel already! However she says she wants to see my ferritin at 50 or higher, but I won’t know my levels until we run labs in a few weeks.

Please take care of yourself and be pushy.