HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Do These Following Blood Reports Indicate?

Posted on Sat, 24 Sep 2016

Question: My mother (58+ yrs) is currently under treatment for Hypothyroidism, Hypertension & Osteoarthritis (stage-2) of knee joints. She is currently on the following medicines -
1) Eltroxin 50 mcg
2) Olmezest 20 mg
3) Gemcal D3
4) Ecod Plus.

I've attached a copy of her recent Kidney, Thyroid, Lipid & Hemogram reports, where her Hb is reported as 10.8 with the blood smear report mentioning "RBCs:Mild anisopoikilocytosis. Predominantly macrocytic normochromic with macroovalocytes. Platelets: Appear mildly reduced in smear. Macroplatelets are seen." Following this, our medicine doctor advised to test Ferritin, B12 & Folic Acid, which also came as normal (report attached), although samples were provided after mild breakfast.

Another thing I wanted to mention is: last year also, she was diagnosed with mild anemia (Hb 10.6, Ferritin 39), however, following 'Orofer XT' for 3-months Hb was improved to 12.4. After that due to gastritis issues, doctor had advised to take 'Orofer XT' once a week & it was stopped 3-months back, when Hb was 12.0.

Answered by Dr. Shailja Puri (29 minutes later)

Brief Answer:
Correction of Hb level after taking iron supplement suggests iron deficiecy

Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.

The blood reports posted by you show normal kidney function tests, normal lipid profile, normal thyroid functions.

The levels of ferritin, folic acid and vitamin B 12 are also within normal limit.
The hemoglobin level is on lower side with anisopoikilocytosis and presence of macrocytes and ovalocytes on peripheral blood.

Low hemoglobin is called anemia.
Anemia can be due to nutritional deficiency of iron, folic acid or vitamin B 12.

The peripheral blood smear shows presence of macrocytes which indicated vitamin B 12 deficiency, however, vitamin B 12 and folic acid came back normal.

Macrocytes can also be present in iron deficiency anemia.
Your doctor has prescribed you iron supplements which has increased the hemoglobin levels up to 12 gm% which is normal for age and sex.

Thus, the iron supplementation was stopped.
You may get hemoglobin level re-checked after few months.
If you have more queries, I will be glad to answer.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Shailja Puri (14 hours later)

Thanks Dr. Puri. Few follow up questions -

1) As you mentioned macrocytes can occur in iron deficiency anemia too, do you think is there a chronic/acute bleeding, which may be invisible for now ? How can we rule out such possibilities ?

2) As per my understanding, if iron is absent in diet, body should get it from the store. How does iron deficiency anemia happen if her Ferritin level is 100 ng/ml ?

3) She had also lost some weight (71 -> 67 kg) in past one year with symptoms like clothes getting loose etc. Is it something alarming ?

4) Do you see any possibility of tumor or liver disorder ? How can we rule them out ?

5) Is the folic acid report reliable as it was for serum folate & taken after mild breakfast only ?

6) Since her B12 level is on higher side (894) of normal, should she still continue Ecod Plus ? Does she need any iron supplements now ? What should we do to correct the anemia ?

Answered by Dr. Shailja Puri (2 hours later)

Brief Answer:
Hb level normal, can be rechecked after 2-3 months, iron can be stopped.

Detailed Answer:
Hello and welcome again,

Answers to your queries are:
1. There can be chronic loss of blood. I suggest stool for occult blood to look for any blood loss in stools due to gastrointestinal tract bleeding.
2. Iron deficiency can occur with normal ferritin level. As the iron deficiency starts increasing, ferritin level too falls down..
3. Loss of weight needs to be investigated. This is usually due to chronic illness or cancer.
4. Normal liver function tests rule out liver disorders. You can get liver function tests also.
5. Folic acid levels can be determined after breakfast.
6. Since, the hemoglobin level is come to normal level, iron can be discontinued. Since, ferritin level is normal iron stores are intact.
hemoglobin can be rechecked after few months.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Shailja Puri (1 hour later)

Thanks Dr. Puri. Few more doubts -

1) Do you indicate Hb 10.8 as normal - correct me if mistaken.

2) Over past couple of years, I can see gradual increase in her MCV (91->95->111) & MCH (27->29->31) values, while decrease in MCHC (33->31->28). This trend does not alter even if Hb is decreased or improved with supplements. Is there any clinical significance ?

3) What is the clinical significance of platelets mildly reduced in smear along with macro platelets present ? This had happened last year too & got corrected within couple of weeks of starting 'Orofer XT'.

4) Just to add: her Ferritin level was 39 & B12 498 before any iron or B12 supplements were started. Does this increase in Ferritin (100) or B12 (894) imply any chronic infection ?

Answered by Dr. Shailja Puri (6 hours later)

Brief Answer:
Hb, ferritin, B12, folic aid are normal. Monitor Hb level regularly.

Detailed Answer:
hello and welcome again,
1.Level of 10.8 is low for age and sex. Hb of 12 is normal.
2. It is important to keep hemoglobin level within normal range. The absolute values are not important but clinical well being is important. Vitamin B12 and folic acid should also be within normal range. The blood reports show normal vitamin B 12 and folic acid levels.
3. The platelets are now corrected, nothing to worry now.
4. Increase in ferritin and vitamin B 12 are due to intake of iron and B12 supplements and not due to any chronic infection.

Thanks and take care
Dr Shailja Puri

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Raju A.T