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What does these abnormal blood tests indicate? - Online Doctor Chats

Date : 08-Apr-2014
User rating for this question
Very Good Posted in: Blood Disorders
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1773 Questions
User:Yes. Thank you. What could the following abnormal blood tests be indicative of:
HCT: 27
Hgb: 9.5
Ferritin: 500
MCV: 106
MCH: 36.5
MCHC:35.5
Thank You
Doctor:Hello
User:Do you see my question?
Doctor:Yes
Doctor:Your hemoglobin levels are low
Doctor:and you have larger than normal red blood cells
Doctor:that means you are suffering from a condition called as megaloblastic anemia
Doctor:this happens because of low vitamin B12 levels
User:How about the high Ferritin.
Doctor:Yes, you do have high ferritin levels
Doctor:that could also be because of the lower utilization of the serum iron to make up the hemoglobin
Doctor:it is all connected
Doctor:you would need to see a hematologist
User:My c-reactive protein is also elevated to 24
User:Do you think I need to see a hematologist or a hematologist oncologist?
Doctor:You will first need to see a hematologist
Doctor:you will need further testing
Doctor:including a bone marrow aspiration cytology
User:What makes you say that?
Doctor:Megaloblastic anemia means abnormal red blood cell maturation
User:Could that be indicative of any type of cancer?
Doctor:No
Doctor:bone marrow study is mandatory in the work up of megaloblastic anemia
Doctor:Probably not indicative of any cancer
User:I also have Crohn's disease. I am going to have a CT scan of my upper Bowel. If that is ok, should I consult with a hematologist oncologist or a hematologist? Are any of these results indicative of any type of cancer?
User:Also, my lipase is elevated to 78. I do not have any other symptoms.
Doctor:Crohn's disease can explain the megaloblastic anemia
Doctor:In my opinion it does not look like any cancer
Doctor:it looks like Vitamin B12 and folic acid deficiency
User:HOw does Crohn's explain the megaolastic anemia? I have not had a flare up in serveral years.
Doctor:since you have Crohn's disease, it can cause these deficiencies
Doctor:Crohn's disease interferes with absorption of the vitamins B12 and folic acid
Doctor:so it can cause megaloblastic anemia indirectly
User:Can my gastroenterologist diagnose the megaloblastic anemia or do I need to see a hematologist? Also, I have had the Crohn's for 24 years. Is it normal for these results after all that time?
Doctor:Yes, you can expect these results after such a long time too
Doctor:however, it is best to consult a hematologist for the anemia part
Doctor:Your gastroenterologist will invariably refer you to one
User:He wants to refer me to a hematologist oncologist?
Doctor:both are essentially same
Doctor:so it doesn't actually matter
Doctor:however, I am positive that your reports do not indicate any cancer
User:OK. Also, my lipase is elevated at 78 and my platelets are 8. Also, my RBC distribution width is elevated. Any thoughts?
Doctor:You will need further testing to rule that out
Doctor:Lipase is slightly elevated, could be a part of Crohn's
User:You mentioned further testing to rule "that" out. What is "That"?
Doctor:Red cell distribution can be altered in megaloblastic anemia
Doctor:by "that" I meant cancer, since you are worried about cancers, by bone marrow study any blood cancers can be ruled out
User:But in your opinion, my labs do not indicate any signs of a blood cancer?
User:Is a bone marrow test needed for diagnosis of megaloblastic anemia?
Doctor:Yes, that is correct, your current blood reports and your medical history do not indicate any blood cancer
Doctor:Not necessarily, but it is one of the tests that is done routinely in megaloblastic anemia
User:And with Mealoblastic Anemia the hgb is low and the ferritin is elevated correct? Are there other symptoms?
Doctor:That is to find the exact cause, to differentiate between vitamin deficiency megaloblastic anemia from bone marrow suppression
Doctor:With megaloblastic anemia, the red cell width will be increased
Doctor:Hematocrit will be low
Doctor:MCV(Mean corpuscular volume) will be high
Doctor:And you will fell generalized weakness
Doctor:feel
User:And will the ferritin be high?
Doctor:yes
User:Also is bone marrow suppression indicative of cancer?
Doctor:ferritin levels will be high
Doctor:No
Doctor:bone marrow suppression does not mean cancer always
Doctor:in some cases yes, but not always
User:What else could it indicate?
Doctor:Your blood report is very clear
Doctor:it is clearly saying that you have megaloblastic anemia
User:Could my internist also diagnosis this by looking at the blood work?
Doctor:Yes
User:Thanks so much for your time.
Doctor:your internist will also be able to diagnose without any problem
Doctor:You are most welcome
User:so a visit to a hematologist isnt necessary
Doctor:is there anything else ?
Doctor:You are right
User:Thank You.
Doctor:you can instead visit your internist
Doctor:Thank you for consulting me here
Doctor:have a great day ahead
Doctor:take care
Doctor:bye
User:My vitamin B12 is normal. I just checked my labs. It is 401.
Doctor:Oh okay
Doctor:what about the folic acid levels
Doctor:?
User:I am checking
Doctor:okay
User:Folate Serum was 12.5. Is that normal?
User:Is that the same as folic acid
Doctor:Yes
Doctor:it is same as folic acid
Doctor:can you tell me the units
Doctor:it is 12.5 .....?
User:doesn't say....
User:Does B12 need to be low for it to be megaloblastic anemia?
Doctor:Not necessarily
Doctor:both vitamin B12 and Folic acid can cause megaloblastic anemia
User:B12 is 401
Doctor:independently of each other
Doctor:Yes, Your B12 seems to be fine
Doctor:but without the units mentioned the numbers do not make any sense
User:Folate is "borderline low" Does that help?
Doctor:Okay
Doctor:that means it is low
Doctor:So, there you have it
Doctor:Folate deficiency is what is causing the megaloblastic anemia
User:How about the low Hgb at 9.5?
Doctor:You might have to ask for a red cell folate levels, that is more sensitive than serum folate levels
Doctor:Anemia means low hemoglobin
User:THey also want to check my pancreas in a
User:Cat scan. Why would that be?
Doctor:It is because of the elevated lipase levels
Doctor:They just want to make sure that you do not have any pancrease inflammation
User:Could inflammation be indicative of the Crohns or possibly cancer?
Doctor:Inflammation will be indicative of Crohn's
Doctor:not cancer
User:Even if I am not symptomatic?
Doctor:yes
Doctor:or it could just be a completely different issue
User:Such as?
Doctor:if you had consumed alcohol a day before you gave the blood samples, that could raise the lipase levels
Doctor:Pancrease inflammation is mostly due to alcohol consumption
User:These results were not fasting. Is that OK?
Doctor:Yes
Doctor:that is fine
User:Which type of blood test results are more indicative of cancer? WBCs? and what else?
Doctor:I would not consider 67 to be worrisome
User:What is 67?
Doctor:Cancers are not usually detected by these blood tests
Doctor:You mentioned that your lipase level was 67, is it not?
Doctor:I was referring to that
User:Actually Lipase ws 78
Doctor:Oh okay, still not much elevated
Doctor:If you get it retested it might come back normal
User:But just a question: Are abnormal WBC labs more indicative of cancer?
User:I thought abnormal HCT and HgB can also be indicative of cancer?
Doctor:Abnormal shapes and immature WBC can be indicative of particular types of blood cancers
Doctor:No
Doctor:HCT is hematocrit, it is just a measure of hemoglobin
Doctor:and hemoglobin is not indicative of any cancer
User:Oh. Thanks. Also does my RBC 2.60 make sense?
Doctor:hemoglobin levels can be low because of low iron intake
Doctor:RBC 2.6 also points to vitamin deficiency
Doctor:and possibly aplastic anemia
User:Which vitamin?
Doctor:meaning, the RBC are not forming in adequate numbers
Doctor:Folic acid
User:Oh. Also, I knew someone diagnosed with lymphoma that had very low hgb
Doctor:Yes, that maybe secondary to bleeding
User:Oh. That makes sense
Doctor:if you have chronic bleeding which is hard to notice, you will land up with low iron, that will result in low hemoglobin
User:What are the treatments for the two anemias you mentioned?
Doctor:If it is vitamin deficiency, then taking that vitamin will correct the issue
Doctor:if it is aplastic anemia, then the reason for that needs to be looked for
Doctor:it is generally due to some of the medications you might be on
User:What are some reasons for it?
Doctor:so stopping the medication will usually solve the problem
User:Which meds?
Doctor:Many medicines can cause aplastic anemia
User:I am on an immunosuppressent. could that be one?
Doctor:like steroids or immunosuppressants etc
Doctor:Yes
Doctor:If you are on immunosuppressants then that will be the culprit
Doctor:Since you said your RBCs are only 2.6, I would consider your condition as a mixed type of anemia
User:But I have been on them for almost 20 years.
Doctor:that is aplastic as well as megaloblastic anemia
User:Both treatable?
Doctor:Yes
Doctor:both can be treated
Doctor:the treatment will be to stop your immunosuppressants for some time
Doctor:and you will need some folic acid supplements as well
Doctor:Considering all these, it is best if you consult a hematologist
Doctor:and please tell him/her that you are on immunosuppressants before you say anything else
User:Thank you. You have been very helpful.
Doctor:It was my pleasure
Doctor:bye
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