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Medical Forum / Diseases and Disorders / Lupus / April 2008Flagged low RBC + everything else lowish
I'm unsure where to post this, but my wife's CBCs have been getting worse over the past 5 years. This year, her RBC is flagged low on each test (with differential). She hasn't been diagnosed with lupus or anything else but I thought you all might be knowledgeable about this. Her PCP keeps saying that "it's just a little low, nothing to worry about" but this just keeps getting lower each time she checks it. She has a low RBC, lowish WBC, lowish hemoglobin, lowish hematocrit, and lowish RDW, low-norm platelets, everything else was normal: MCV, MCH, Neutrophils, etc. WBC: 4.4 (ref 4 - 10.5) RBC: 3.76 LOW (ref 3.8 - 5.1) Hemoglobin: 12 (ref 11.5 - 15) Hematocrit: 35.1 (ref 34 - 44) MCV: 93 (ref 80 - 98) MCH: 32 (ref 27 - 34) RDW: 11.9 (ref 11.7 - 15) Platelets: 166 (ref 140 - 415) Neutrophils: 65 (ref 40 - 74) Lymphs: 23 (ref 14 - 46) Monocytes: 8 (ref 4 - 13) Eos: 3 (ref 0 - 7) Basos: 1 (ref 0 - 3) Neutrophils Absolute: 2.9 (ref 1.8 - 7.8) Lymphs Absolute: 1 (ref 0.7 - 4.5) Monocytes Absolute: 0.4 (ref 0.1 - 1) Eos Absolute: 0.1 (ref 0.0 - 0.4) Baso Absolute: 0.0 (ref 0.0 - 0.2) Any ideas? I'm cross posting to sci.med in case this is the wrong group. Thanks for any ideas. Your wife's blood work doesn't look too bad really. My white counts are in the 3.8 range and my red cells are very low as well. My rheumy says the same as her's does. it is low but ok range not to worry. So I don't try to dwell on it. If it was too bad I am sure your doctor would worry. But the norms are in a good range even with it being low normal range. I gather you said they get lower with each time, tis true for myself.Then all of a sudden they go up. WHY? have no clue. But at least she is being monitored and that is great news too. Just keep tabs and hope for the best. Tis what I do and have too. Low red cells bother me because of anemia but if that happens the volumes change also as well as hemoglobin and hematocrit. They weigh all them tests to decide anemia and what is causing it. I would not worry too much Is she on iron and or vitamins with high B complex? AND NO I AM NOT IRON JUSTICE LOL. good for you to monitor and help your wife so much janers > Your wife's blood work doesn't look too bad really. My white counts are in the 3.8 range and my > red cells are very low as well. My rheumy says the same as her's does. it is low but ok range not [quoted text clipped - 15 lines] > good for you to monitor and help your wife so much > janers Janers, Thanks for the reply.. I got two replies, that's nice. She takes truck loads of B vitamins because she has a thyroid issue (I forgot to mention, but will in Robert's reply). She doesn't take a multi vitamin but I'll ask her to! Thanks, Richard > I'm unsure where to post this, but my wife's CBCs have been getting > worse over the past 5 years. This year, her RBC is flagged low on each [quoted text clipped - 30 lines] > Any ideas? I'm cross posting to sci.med in case this is the wrong > group. Thanks for any ideas. You don't state your wife's age or any other medical conditions she might have. In general folate deficiency is common as one gets older as is B12 deficiency. With any chronic illness then there is also anemia of chronic disease that one has to contend with. Thyroid disorders also tends to occur with increasing age also along with other primary bone marrow disorders and medications can also cause anemia. Folate and B12 deficiencies can cause low white cell counts and platelets. The RDW is normal and not elevated and so the cells are fairly uniform in size. This tells me that the new red cells are not elevated as the young cells are usually larger than the mature red cells. Those that are bleeding or with hemolysis would tend to have a higher production of those cells. The only sure way is to do a retic count to see what the red cell production is. Here again a history of bleeding or malabsorption problems like celiac disease is important. She hasn't crossed the line into anemia as yet as it is defined by a decreased hemoglobin or hematocrit, Once it does cross that line then it can be further divided into those with decreased hemoglobin content MCHC and red cell size MCV which can give clues in terms of origin. With other counts decreasing then pancytopenia is something to keep an eye on. So the clinical context is important in knowing what's going on with your wife and how to interpret the labs. A multi-vitamin is a safe bet. > > I'm unsure where to post this, but my wife's CBCs have been getting > > worse over the past 5 years. This year, her RBC is flagged low on each [quoted text clipped - 34 lines] > might have. In general folate deficiency is common as one gets older > as is B12 deficiency. My bad! She is 31 years old and she does have hashimoto's thyroiditis, and she takes Armour for that. She doesn't have any other conditions though. She did have a blood test for B12 and folate, both of which were right in the middle of the reference range. I don't know what ferritin was but serum iron was 78 (ref 35 - 155) :-( > With any chronic illness then there is also > anemia of chronic disease that one has to contend with. Thyroid [quoted text clipped - 8 lines] > count to see what the red cell production is. Here again a history of > bleeding or malabsorption problems like celiac disease is important. One doctor said that she might have endometriosis, because she bleeds rectally during her menstrual.. Again, her PCP and OBGYN both ignore this problem. One other thing, she was born with thymus hypoplasia but her immune system is "ok" according to the PCP. Oh one other thing, her blood pressure has always be really low, like 90/60! > She hasn't crossed the line into anemia as yet as it is defined by a > decreased hemoglobin or hematocrit, Once it does cross that line then > it can be further divided into those with decreased hemoglobin content > MCHC and red cell size MCV which can give clues in terms of origin. > With other counts decreasing then pancytopenia is something to keep an > eye on. Shoot, pancytopenia is scary. > So the clinical context is important in knowing what's going on with > your wife and how to interpret the labs. A multi-vitamin is a safe > bet.- Hide quoted text - She's going to try a multi-vitamin. I hope its not pancytopenia. Maybe because she has hashi's, she might have auto-immune aplastic anemia? hope not! Thanks, Richard > - Show quoted text - > > > I'm unsure where to post this, but my wife's CBCs have been getting > > > worse over the past 5 years. This year, her RBC is flagged low on each [quoted text clipped - 85 lines] > > - Show quoted text - I just uploaded her results including liver, metabolites, thyroid, etc. this was drawn just yesterday and we got the results today through LabCorp: http://www.corpdns.net/temp/labs/laura.png Thanks, Richard > > > > I'm unsure where to post this, but my wife's CBCs have been getting > > > > worse over the past 5 years. This year, her RBC is flagged low on each [quoted text clipped - 94 lines] > > - Show quoted text - I am not a doctor and so my comments are strictly for discussion and not implied as a diagnosis anything nor pretending to diagnose anything. Hypothyroidism can cause anemia although as mentioned it isn't anemia yet. The mechanism seems to be decreased erythropoietin levels secondary to a decreased lessened peripheral oxygen requirements. Conversely hyperthyroidism can result in anemia, low white counts and low platelets ie pancytopenia. http://www.thyroid.org/patients/notes/july06/06_07_25.html I have some doubts about the thyroid panel that include a T7 meaning they did a free thyroxine index through the use of a T3uptake test. That is pretty much outdated and being discouraged. The replacement test is the actual measurement of the free T4 thyroxine. You did not post the TSH measurement and so that is important and hopefully under control and not too high or not too low. Third generation testing is also more accurate with greater sensitivity with regards to the TSH. There can be other endocrine causes for anemia including hypoadrenalism and hypopituitary issues. The glucose is normal which is good along with the other electrolytes and there doesn't seem to be any dehydration or eosinophilia etc. There are other conditions such as autoimmune hemolytic anemia which comprises about 12% of all normocytic mild anemias ( less than 10 g/dl ) in which the retic would help in such cases. Again no where near the anemia level that we are talking about. The serum iron seems to be OK and the cells are not getting smaller which usually indicates iron deficiency associated with excessive blood loss. With early iron deficiency the MCV might not be low but again the serum iron would be low. Pernicious anemia can also be associated with hypothyroidism due to the autoimmune nature of the conditions and there increase association with other autoimmune conditions. The B12 is normal and it argues against that at first glance although each organ system utilizes B12 at different rates and one can be deficient neurologically with a normal blood level and urine levels of methylmalonic acid might be better suited for that in the presence of neurological symptoms. Good luck and as I said it really takes clinical correlation that only the doctor can bring to it. Most of the labs there are normal and only the low normal levels as mentioned. It is best to monitor especially the TSH. One does not want to get it too low as that might generate problems also. She looks mildly anemic to me with a 35 crit. Might consider some ion suppliments along with Vit C (gotta take both for the iron to work). AND I'TS NOT IRON MAN TALKING HERE!! Just my 2 cents worth (25 cents, adjusted for inflation!)] Michael P.S. Are we supposed to be top posting here or bottom posting? Been so long I can't remember. > > I'm unsure where to post this, but my wife's CBCs have been getting > > worse over the past 5 years. This year, her RBC is flagged low on each [quoted text clipped - 56 lines] > your wife and how to interpret the labs. A multi-vitamin is a safe > bet. In message <9a60ff10-703e-46c4-b374-74b3295503c8@u36g2000prf.googlegroups.com>, Michael <mikeroeper@msn.com> wrote [ >P.S. Are we supposed to be top posting here or bottom posting? Been so >long I can't remember. Bottom is nicer :)  SignatureAndy Taylor [Editor, Austrian Philatelic Society; Chair, N E Lupus Group]. Visit <URL:http://www.austrianphilately.com> or <URL:http://www.northeastlupus. org.uk> for the obvious; Andystuff on <URL:http://www.kitzbuhel.demon.co.uk> For who? got ya hugs, Shelagh http://clik.to/lupus 'Life isn't about how to survive the storm, But how to dance in the rain.' ________________________________ Michael <mikeroeper@msn.com> wrote [ >P.S. Are we supposed to be top posting here >or bottom posting? Been so >long I can't remember. "Andy" <andy@kitzbuhel.demon.co.uk> wrote in message >>Bottom is nicer :) Nicer 'how' Andy? ;) What I am saying/meaning is that, when OE sets up the email upon reply or forward with inserting the signature, it always sets up for response on top of the included text replied to.... so seems to me that the 'correct' way then, would be to respond on top ....? <see above -- done before I typed a single letter> However, personally? I like to answer as I read and to do different colored response text in between the original email text lines..... just as I am doing here...without the color changes due to plain text, no html, with news posting. But, IMHO ? ...chacun a son gout! or <to each - their own> ___________________________________ > hugs, > Shelagh [quoted text clipped - 24 lines] > <to each - their own> > ___________________________________ This subject is a never ending cause of flame wars on other groups let's not start that here. Before Outlook (Express) all mail and news clients were set up tp bottom post with a signature delimmiter at the bottom so that clients could strip the "sig" from the reply. O(E) broke that so that all the original post was below the delimmiter and ends up being stripped. This can be fixed with the addition of QuoteFix to O(E). I Shelagh's response here you can see that the "sig" was placed at the top of the message without a delimmiter. Bottom posters say that you read from top to bottom so posting in this style keeps things in order. Top posters say that you can read to reply without scrolling through the previous parts of the messages before getting to the reply. Both of these rarely snip any of the original text. Interleaved responses are ususally the best leaving only that which is being responded to. All have there plusses and minuses. AGGREEMENT WILL NEVER BE REACHED. My opinion for this group is to follow the style of the first response in the thread. It has not been an issue here, let's keep it that way. The one thing that should not be done on USENET is to post in HTML unless the group is specifically set up for that (rare). Worse is posting in Multi-part, Three times the message size that is required and many readers show all the formatting making it nearly immpossible to read. JMO FWIW Timothy I just wrote a lovely post then lost the whole darn thing. I used OE for years without fully understanding the language used as mentioned in th last 2 posts. I barely know how to post a reply acually. I dropped out of all NG's several years ago when that horrible woman who used to post the tons of jokes there on the Fibro group....I made the mistake of saying something about it (the jokes) and she went balistic on me, taking collective posing I had done in another group and posted it in the Fibro grp to embarrasss me. At the time I didn't know that our posts were archieved for as long as spent nuke waste lasted on the planet... 'I'm using Vista's "Windows Live Mail" now and I only understannd the very surface of that thing, certainly not on the level as the stuff was discussed in the last 2 posts. It's incredibly hard for me to learn this new stuff. I write paragraphs before realizing I'm learning a laptop now so I'm totally over my head with the keyboard too. I write an e-mail and 4 mInutes into it I realize it and by the time I have it cleaned uo I;m nodding off again, usually with my ekbow or something on the "X" key, filling 9 pages with X's. By the time I get that cleaned up, it;s time for another nap. So you see, I'm simply flying way too high without a net here! Everything takes sso long because I's so sleepy and all. I've had so give up driving, other now drive, shop and ck=lean for me. My biggest worry anymore is what to o when I get to that point they're warning me will come...when I can't take care of myself. I'll promise to try and understand what's been written here and do things in the ight format. Michael |
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