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Suggest treatment for abnormal CBC results - Online Doctor Chats

Date : 21-Apr-2014
User rating for this question
Very Good Posted in: Blood Disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2585 Questions
User:I am a 55 year old male. I have had abnormal CBC results for several years since an extended stay in the hospital that resulted in over 20 units of blood by transfusion over an 8 week period due to internal bleeding. Much has gone back to normal except for the Hemoglobin at 19.3 (range 12.6 - 17.7). It has been between 18.5 and 19.7 on 10 tests over the last 18 months with the most recent being 1 week ago.

My hematocrit is 58.4 (range 37.5 - 51.0) and has been within 2 points for the last 18 months.

My RBC 6.44 (range 4.14 - 5.8) and like the two previous this one has been high on over ten 10 test in the last 18 months.

The new wrinkle in the last 3 months has been a low platelet count. It is 140 (range 155-379) in 3 consecutive tests 30 days apart.

I recently was forced to change insurance plans before my hematologist could perform much in the way of diagnostics. She did a test for bone marrow disease which cam back negative. At the time I was severely anemic. She had me take 60mg of iron sulfate 3 times daily for months. That brought it back into the normal range, but when I stopped taking the iron it started dropping again. I can maintain a low normal iron level taking 60mg a day.

I do have low testosterone and take depo shots monthly, but stopped for 2 months to determine if that was affecting the blood tests and there was no change after 2 months.
Let me read your query for few minutes to be able to have a good discussion here.
Doctor:Currently you have high hemoglobin
Doctor:and low platelet counts
Doctor:am I right?
User:high hematocrit
User:high rbc
User:the numbers are in the message
Doctor:I read the whole question
User:the hemoglobin hematocrit and RBC have been consistently high for 18 months
Doctor:Except for the low platelet counts, all other red cell related abnormalities can be accounted by the fact that you received 20 transfusions
User:the low platelets in new in the last 3 months
Doctor:Massive transfusions do increase the total iron content in the body
User:how could the transfusions from 2 years ago still be affecting my blood
Doctor:hence the higher RBC counts, higher hematocrit and high hemoglobin
User:I was severely anemic thoug
Doctor:When was that?
User:last 8 months
User:I had literally no iron
User:the hematologist had me take 60mg iron sulfate 3 times daily
User:after 3 months it was in normal range
Doctor:Oh, okay, you mean the rise in hemoglobin is recent?
User:after I stopped it started dropping again
User:no hemoglobin has been hig for 18 months
User:hemoglobin rbc and hematocrit for 18 months
User:anemia for a year
Doctor:If hemoglobin was high for the last 18 months that is not anemia
User:I now take 60mg daily to keep it in low normal
User:I had high hemoglobin and virtually no iron
Doctor:Anemia is when your hemoglobin levels are lower than 11 gm%
User:the hematologist wanted to give me an iron infusion
User:hence my concern
Doctor:That is not necessary at all
User:should not have high rbc - high hemoglobin - and low platelets
Doctor:Plasma iron levels may be low because all the iron was being utilized to produce hemoglobin
User:why then am I producing high hemoglobin
Doctor:did your hematologist ever do a peripheral smear or bone marrow study?
User:just a blood test for a bone marrow disease
Doctor:Iron was being utilized to produce more hemoglobin
Doctor:so you had low plasma iron levels
Doctor:but high hemoglobin
Doctor:It is hard to say why without a bone marrow study
Doctor:and erythropoetin levels
Doctor:you would need to get these two done to determine the exactly what is going on
User:so I need to go to another hematologist?
Doctor:You do not have anemia based on your hemoglobin and hematocrit values
User:she did not say
User:she did not think so
User:she said it would be ok once I got it back in normal range
Doctor:It is actually contradicting
User:but iron continued to deplete
Doctor:your plasma iron values and hemoglobin contradict
User:I still take supplements to keep it in normal range
Doctor:so there is something else going on
Doctor:In my opinion you should stop the supplements
User:I did stop for 30 days
Doctor:Okay, what happened then?
User:nothing changed but my iron level dropped
User:hemeoglobin has been slowly climbing
Doctor:It is okay, if your hemoglobin levels and hematocrit levels are fine, then you don't need to take iron supplements
User:I have cbc done monthly
Doctor:I strongly suspect some problem with erythropoetin levels
User:but iron levels are low
Doctor:I know
User:ok - you have answered my question
User:I need to get back to the hematologist
Doctor:that is what I am trying to explain to you, your iron levels are low because the iron is being used up to produce hemoglobin
User:which it should not be doing correct?
Doctor:Yes, it should not be doing unless your hemoglobin level is low
Doctor:So the suspicion is high erythropoetin secretion
User:I assume my bone marrow produces hemoglobin?
Doctor:Yes, bone marrow is where RBCs are produced
User:ok - thanks
Doctor:RBCs are filled with hemoglobin in the bone marrow
Doctor:Is there anything else I can help you with?
User:you have answered my question
User:have a good day
Doctor:I am happy to know that I could help you
Doctor:You too have a great day ahedd
Doctor:take care
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