Brief Answer:
hi i would recommend the following.

Detailed Answer:
Dear sir,
I did review your concern.
Anemia in CLL can be due to various causes and iron supplementation may not necessarily help all the time.
In order to determine exact diagnosis and treatment i would recommend you to please upload your latest hemogram report with wbc, platelet and rbc indices like mcv, mch,rdw. Also please upload your recent bone marrow if done for CLL.

Once I have all the information i will be able to answer your question in detail and accurately.

I hope this helps.
Awaiting your reply with reports.
Please do let me know if you have any more questions or concerns.
Sincerely,
Dr Parth Desai

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Brief Answer:
hi i would recommend the following

Detailed Answer:
Dear sir,
Thank you for your reply.

Your hemoglobin is 12.5 and mcv is 91fl. Iron deficiency is very unlikely with this as in iron deficiency mcv is less than 80. Your mcv is normal and anemia is very mild.
The next step I would recommend is peripheral smear examination, reticulocyte count and if needed a bone marrow examination. Anemias with normal mcv can be due to many cause including mild hemolysis or progression of CLL. These tests will help us better to know the proper treatment you will need.

I hope this helps sir.
Let me know if you have any concerns.
Wish you all the best.
Sincerely,
Dr Parth Desai

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Brief Answer:
hi i would recommend the following.

Detailed Answer:
Dear sir,
I did review the uploaded report that is of genetic analysis of bonemarrow. It shows 11q deletion which i believe would be in CLL cells and indicates poor prognosis. However i did not find any bone marrow histopathology report indicating the extent of involvement by CLL which wouls also explain probably the anemia you are developing. It might also help in deciding to change the current managment for CLL.

I hope this helps sir.
Let me know if you have any other questions or concerns.
Wish you all the very best.
Sincerely,
Dr Parth Desai

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Brief Answer:
Hi I would recommend the following.

Detailed Answer:
Dear sir,

Thank you for your reply .
I did review the biopsy report. The infiltration by cell is still in its early stages and it is likely that hemoglobin is decreasing likely due to infiltration. Also the iron stores were not demonstrated which is in contradiction to mcv findings. In such discordant finding, an iron study may now be helpful to determine if iron can help raise some hemoglobin. Also i would recommend peripheral smear and reticulocyte count if not already done.

As far as starting treatment with antibody n chlorambucil, it is prudent to start only after hb falls below 10.5-10g/dl.but if the hemoglobin can be corrected by other measures it should be diagnosed and tried first.
I hope this helps sir.
Let me know if you have anymore concern or question.
Wish you all the very best.

Sincerely,
Dr Parth Desai

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