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Labs showed anisocytosis. Will it subside if old blood cells die off?

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I have had iron deficient anemia for close to a decade. Heavy periods. I'm now perimenopausal with very irregular periods. Some are heavy and last a long time and at other times I can skip a month or two. I'd given up on taking iron supplements for a long time because they always made me very sick. Last January I decided to try the iron pills one more time. In the meantime, I went to a health fair and had a free kidney screening. When I got the results back it said that my hemoglobin was now 12. something but that I was +1 anisocytosis. I looked all that up and found that it means I have irregularly shaped blood cells. And that this condition is charactized by extreme fatique. When I asked my doctor about this today, he dismissed my thoughts that my fatique is related to the anisocytosis. He suggested instead that I could probably have sleep apnea. He asked me if I snored, and I said no not since I'd lost 80 pounds. He then decided that I still probably could benefit from a sleep study with the idea that I probably do have sleep apnea even in the absense of snoring (ok, I can buy this) and that my fatigue could be caused by a lack of oxygen during sleep. Well I don't have insurance and I don't have money to pay for a sleep study out-of-pocket so I'm not going to be able to rule out sleep apnea anytime soon as a cause of my fatigue. So my question is this. If the anisocytosis can cause my fatigue and I recently stopped being anemic, could the anisocytosis eventually correct itself as old blood cells die off and are replaced by hopefully new healthy ones? Would that theoretically eleminate my fatigue if the anisocytosis is the cause and not the sleep apnea as I suspect?
Posted Thu, 16 May 2013 in Blood Disorders
 
 
Answered by Dr. Chakravarthy Mazumdar 3 hours later
Hi,

So fatigue is your main worrying symptom.

Since you are perimenopausal that explains you the irregular period and skipping periods.

Let me explain that anisocytosis is a result of some worrying cause. It is not the cause but a reflection of defective RBC manufacturing without essential elements needed during RBC making. The most common elements being Iron , VitA or B12, RBC enzyme def, Thalassemias etc. What you had free testing it was Hemoglobin (12gm/dl) which does not depict whether Iron is corrected or not.

I suspect, Iron deficiency, if you had stopped the Iron pills long back, it prevails and causes fatigue. You need to test for Serum Ferritin levels, MCV, MCH levels as well.

The other reasons for fatigue is medication induced. With multiple pills that you use there is a high chance of mineral and vitamin deficiency. They are B12, Folic Acid, Melatonin, B6, Phosphorus, Selenium, Mg etc. These are result of medicines using these minerals to act on the body. It is good if your doctor can add good multivitamin supplements as well.

To answer your queries, if you correct the above causes then anisocytosis is corrected as well. Testing for sleep apnoea with a past history is fair but not the next best step.

Hope this helps.

Above answer was peer-reviewed by
 
Follow-up: Labs showed anisocytosis. Will it subside if old blood cells die off? 18 hours later
Thank you for the information. You have really confirmed what I've suspected dispite the fact that my doctor really won't entertain this discussion.

On the lab report from the kidney screening it shows that my MCV is 39.4 and my MCH is 89.1, both of which are in the normal range.

Unfortunately, it says nothing about the Serum Ferritin levels. From what I read and if I understand what I read correctly, the Serum Ferritin levels indicate whether my body is storing enough iron. Is that correct. So dispite the fact that my hemoglobin is 12.6, would Serum Ferritin levels indicate if I don't have enough in reserve? Why is that important? If I'm on the wrong track here, please explain. Also why would the blood results on the kidney screening report not include Serum Ferritin levels when it's so detailed about everything else to do with my blood. Is there a screening that I could do specifically for Serum Ferritin levels?

By the way my RDW is 20.9 H all the readings below that is

Anisocytosis 1+
Ovalocytes 2+
Review of peripheral smear confirms automated results

Now if I understand the ovalocytes reference, it means that I have an unusual amount of oval red blood cells, is that correct?
 
 
Answered by Dr. Chakravarthy Mazumdar 7 hours later
Hi,

Please check the MCV and MCH values. The values that you typed are definitely not normal. MCV is very low. I think you have typed the other way. MCV is 89 and MCH is 39.4. Is it not?

If MCV is normal and MCH is also normal there is very unlikely chance of Iron deficiency. You do not need Serum Ferritin. This is not done during routine screening hence the free kidney profile does not include Serum Ferritin. Yes serum Ferritin indicates iron stores.

High RDW (red cell distribution width) indicates that the RBC shape and size are variable. We often see Ovalocytes and Anisocytosis with high RDW. So what I understand elevated RDW and normal MCV is associated with the following conditions:
Early iron, vitamin B12, or folate deficiency (actually common after severe iron deficiency)
Dimorphic anemia (for example, iron and folate deficiency)
Chronic liver disease
Myelodysplastic syndrome

Ask your doctor about these now. You are right about ovalocytes but is normal to find them on routine peripheral smear.
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Follow-up: Labs showed anisocytosis. Will it subside if old blood cells die off? 16 hours later
"Please check the MCV and MCH values. The values that you typed are definitely not normal. MCV is very low. I think you have typed the other way. MCV is 89 and MCH is 39.4. Is it not?"
Per my report, the MCV value is correct and falls within range
MCV
89.1 fL

Range
80.0-100.0 fL

The MCH value I sent you in the previous question DOES need to be corrected per my report; it is as follows
MCH
28.5 pg

Range
27.0-33.0 pg
According to the report my MCH is within acceptable range as well

So from what I'm understanding and based on your clarifications, if I can stay out of the anemic range, the issue I'm having with the anisocytosis will likely correct itself in time. What about the ovalocyte issue, will that clear up in time as well?

If MCV is normal and MCH is also normal there is very unlikely chance of Iron deficiency. You do not need Serum Ferritin. This is not done during routine screening hence the free kidney profile does not include Serum Ferritin. Yes serum Ferritin indicates iron stores.


"If MCV is normal and MCH is also normal there is very unlikely chance of Iron deficiency. You do not need Serum Ferritin. This is not done during routine screening hence the free kidney profile does not include Serum Ferritin. Yes serum Ferritin indicates iron stores. "
This is good to know. Thank you.

"High RDW (red cell distribution width) indicates that the RBC shape and size are variable. We often see Ovalocytes and Anisocytosis with high RDW. So what I understand elevated RDW and normal MCV is associated with the following conditions:
*Early iron, vitamin B12, or folate deficiency (actually common after severe iron deficiency)
*Dimorphic anemia (for example, iron and folate deficiency)
*Chronic liver disease
*Myelodysplastic syndrome"

Well, with regard to chronic liver disease, my doctor checks my liver regularly so I'd hope if this were the case we'd know if my liver was an issue.

When it comes to the early iron, viamin b12 or folate deficiency, should I have my doc check for for these? What do you mean by "early iron?" Not sure what you're referencing here.

Myelodysplastic syndrome. Ok looked this up and that's pre luekemia. I'm certainly not going to worry about this. I don't want to become a hypochondriac, (laugh out loud) I'll keep this waaaaaay on the back burner.

Dimorphic anemia. Two types of anemia at once. This is an interesting possibility. I think I'll ask my doc about this one. Do you think it's a good idea to ask him to check for vitamin and various mineral deficiencies?

So this is my last question. I look forward to reading your answers. Thanks in advance for all the information. You've been very helpful.
XXXXXX
 
 
Answered by Dr. Chakravarthy Mazumdar 9 hours later
Hi,

Answers

1) So from what I'm understanding and based on your clarifications, if I can stay out of the anemic range, the issue I'm having with the anisocytosis will likely correct itself in time. What about the ovalocyte issue, will that clear up in time as well?

-- Yes they correct by themselves after the cause is corrected. Ovalocyte is quite normal if it is under 1%. You do not need to retest with peripheral blood smear to check if they are corrected or not.

2) When it comes to the early iron, Vitamin B12 or Folate deficiency, should I have my doc check for for these? What do you mean by "early iron?" Not sure what you're referencing here.

-- you can ask the doctor to check for other symptoms and signs of deficiency. Many a time the iron stores are under corrected though the MCV and MCH come back normal.

You do not need to worry about Myelodysplastic syndrome. Yes it is good idea to check for vitamin and mineral deficiency.

However in this part of the world it is cost effective to put a suspected person on multivitamins and minerals for few months and keep an eye on the symptoms than testing blood for specific vitamins and multi minerals. It is up to you and your doctor.

Hope this helps.
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