What kind of anemia is this?

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biggero - 19 Apr 2008 13:54 GMT

Here are the results of my recent lab tests:

RBC: 5.75*10^12 / L (normal 4.1 - 6)
HCT: 45.6 % (normal 40 - 54)
MCV: 79.3 (normal 79 - 96)
MCH: 25.8 (normal 26 - 32) - LOW
RDW: 15,6 (normal 11.5-14.5%)
Reticulocytes: 1.89 % (normal 0.5 - 2.0 %)

but:
Reticulocytes count = Reticulocytes * RBC =
1.89 % * 5.75*10^12 / L = 108.6*10^9/L (normal 25-75*10^9/L) - HIGH

ESR = 1 mm/h
CRP = never increased, always close to 0

These above are typical results for me after winter.
But after summer, when I have some physical activity the results are
more like sth like that:
RBC: 6.21 (normal: 4.1 - 6.0) - HIGH
MCV: 75.2 (normal: 80-99) - LOW
MCH: 25.1 (normal: 27-35) - LOW
HCT: 46.7 (normal: 40 - 54)

My GP never cared about these results - she only asked if it runs in
my family.
Yes, it runs - my mother and brother have similar results. So, it's OK
- she said and clearly she was completely wrong, because if it runs in
my family this means sth completely opposite - it may be hereditary.

I also had theese tests done, and that's what concerned me.

Serum Iron: 177 mcg/dl (normal 50-120) - HIGH (repeated twice with
the same result)
TIBC: 484 mcg/dl (normal 250 - 450) - HIGH
Ferritin: 128 ng/ml (normal 30-400)

3 years ago I also had serrum iron done and it was 3 times higher than
normal - and this GP of mine also did not care...

So, what is the conclusion?
*It is rather not iron deficiency anemia (high iron and normal
ferritin level).

*It is rather not chronic disease anemia (I had blood test 12 years
ago, when I felt OK, and the results were exactly the same. Now I am
28, so then I was not able to interpret the reslults).

*So it looks rather like hemolytic anemia (or other of this kind -
thallassemia...).
Anyway it looks like it is hereditary.
Erthropesis is normal (increased RBC in the summer, when I excercise),
but when I have increased RBC, even more erythrocytes are destroyed,
what results in even lower MCV and MCH.

It looks like there is high iron turnover (high, serum iron and normal
ferritin). One thing that doesn't match is TIBC - it should be normal.
I cann't find anywhere, what increased TIBC means in this case. Does
anyone know, if it can be increased, because body just wants to get
rid of excess iron?

If I have increased serum iron, can I have symptoms similar to
hyperchromatosis? Afterall these free radicals caused by iron are
there...? I have joint pain (not arthritic, unknown cause), and
usually I don't feel too well.

What other tests can I do (possibly not very expensive) in order to
have differential diagnosis?
I have to go to hematologist, and I want to go to a good one and this
means waiting 8 weeks.
I might also go somewhere else, and I would rather have some data and
ideas, so that they could not get rid of me that easily.

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Robert1 - 19 Apr 2008 19:58 GMT

> Here are the results of my recent lab tests:
>
[quoted text clipped - 7 lines]
> Reticulocytes count = Reticulocytes * RBC =
> 1.89 % * 5.75*10^12 / L = 108.6*10^9/L (normal 25-75*10^9/L) - HIGH

These are my comments for what they are worth.

Normal CBC although the MCV is under 80 and the RBC is not elevated
with a raw normal reticulocytosis percent. The raw count is more of an
index of the red cell life span where as the the absolute reticulocyte
count that you calculated based on the total RBC is a count that
represents red blood cell production. This indicated an increase in
red cell production.

> ESR = 1 mm/h
> CRP = never increased, always close to 0

This is helpful in evaluating the ferritin where it may be falsely
elevated due to inflammation. Inflammation also associated with other
hematological abnormalities.

> These above are typical results for me after winter.
> But after summer, when I have some physical activity the results are
[quoted text clipped - 3 lines]
> MCH: 25.1 (normal: 27-35) - LOW
> HCT: 46.7 (normal: 40 - 54)

There is no anemia in the first CBC or in this CBC. Anemia is defined
as a low hemoglobin, which you don't list but based on the hematocrit
it would be around 15.6 g/dl. An elevated RBC with a low MCV is 75%
sensitive and 97% specific for thalassemia syndromes. A further
diagnosis of thalassemia syndromes would require the test called a
"hemoglobin electrophoresis".

> My GP never cared about these results - she only asked if it runs in
> my family.
> Yes, it runs - my mother and brother have similar results. So, it's OK
> - she said and clearly she was completely wrong, because if it runs in
> my family this means sth completely opposite - it may be hereditary.

She meant that it runs in the family and it is genetic and you have
had it since you were born. You have been fine all these 28 years.
That is what she meant by it is, "OK".

> I also had theese tests done, and that's what concerned me.
>
[quoted text clipped - 5 lines]
> 3 years ago I also had serrum iron done and it was 3 times higher than
> normal - and this GP of mine also did not care...

The transferrin saturation based on the above TIBC X 100 is 36.5%
which is normal. Had the % saturation been in the greater than 80%
range then they would have been concerned. They would have done
deferoxamin provocation test in checking for chelatable iron.

The other reason for doing the iron studies is for ruling out iron
deficiency that may also cause confusion in those with a low MCV and
similar blood smear finding. One does not want to give iron to those
with thalassemia.

> So, what is the conclusion?
> *It is rather not iron deficiency anemia (high iron and normal
> ferritin level).

No conclusions as the workup is incomplete. It is not iron deficiency
correct.

> *It is rather not chronic disease anemia (I had blood test 12 years
> ago, when I felt OK, and the results were exactly the same. Now I am
> 28, so then I was not able to interpret the reslults).

More importantly it seems you haven't' mentioned any chronic illness.

> *So it looks rather like hemolytic anemia (or other of this kind -
> thallassemia...).
> Anyway it looks like it is hereditary.
> Erthropesis is normal (increased RBC in the summer, when I excercise),
> but when I have increased RBC, even more erythrocytes are destroyed,
> what results in even lower MCV and MCH.

A look at the blood smear and comments as to Red cell morphology would
go a long way in pointing one in the right direction. The number of
target cells, basophilic stippling, abnormal shape of cells, envelope
forms, hemoglobin crystals etc all can be useful info.

> It looks like there is high iron turnover (high, serum iron and normal
> ferritin). One thing that doesn't match is TIBC - it should be normal.
> I cann't find anywhere, what increased TIBC means in this case. Does
> anyone know, if it can be increased, because body just wants to get
> rid of excess iron?

TIBC is actually a surrogate test for transferrin, a protein that is
created by the liver like most proteins. What is important is the
percent saturation. There are conditions that increase and decrease
the protein production of transferrin.

http://www.labtestsonline.org/understanding/analytes/tibc/test.html

> If I have increased serum iron, can I have symptoms similar to
> hyperchromatosis? Afterall these free radicals caused by iron are
> there...? I have joint pain (not arthritic, unknown cause), and
> usually I don't feel too well.

You are not in the hemochromatosis range, Transferrin saturation >
45-50% or greater than 200 mcg/L.

> What other tests can I do (possibly not very expensive) in order to
> have differential diagnosis?
> I have to go to hematologist, and I want to go to a good one and this
> means waiting 8 weeks.
> I might also go somewhere else, and I would rather have some data and
> ideas, so that they could not get rid of me that easily.

The workup is pretty straight forward.

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