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Complaining of aches and pains. HIV and Hep C negative. Consumes alcohol. WBC and iron level are low. Suggestion?

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My son (33) has a WBC of 1.9, with absolute neutrophils of 1.0, absolute lymphs of 0.5, and absolute monocytes of 0.3. He has been complaining of aches and pains, most recently in shoulder and side. Sed rate was 22, iron saturation 8%, HIV (and Hep C) were negative. Has been a chronic alcohol abuser.
Posted Tue, 30 Jul 2013 in Liver and Gall Bladder
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the query,

Alcohol has systemic (generalized) effects on almost all systems of the body. Especially on the gastrointestinal system (stomach and liver) and also on the immune system.

Chronic consumption of alcohol could lead to a decrease in the immune response of the body. White Blood Cells (WBC) levels in his case are very low. These low levels are actually expose him to many multiple infections. The erythrocyte sedimentation is slightly raised. The normal for his age should be less than 20. It would be necessary for this measure to be repeated, or for another measure of acute inflammation (C reactive Protein) to be measured to be sure of the state of inflammation. The erythrocyte sedimentation rate is also highly exposed to variations with food, temperature, type of measure). It s worth repeating. His iron saturation rate is actually very very low. The normal is 15 to 25%. This could be due to anemia whose origin has to be investigated. Other tests like a complete blood count, with parameters of the hemoglobin levels could help in better characterizing the anemia. Being macroytic anemia is commonly seen in chronic alcohol consumption.

Alcohol consumption decreased appetite leading to reduced intake of nutrients needed for red blood cell synthesis thus contributing to anemia. Alcohol irritates the stomach. Chronic inflammation of the stomach causes secretion of Vitamin B12. Vitamin B12 is very important for Fe re-absorption in the intestines. This could be a perfect explanation of the anemia (low iron saturation in his case).

Vomiting of blood could have two main explanation commonly seen in alcohol consumption. These patients do not eat most of the time,and taking alcohol leads to direct stomach irritation and gastritis which can easily lead to gastrointestinal bleeding. Secondly, in case of chronic consumption of iron leading to cirrhosis of the liver, a state generally called Portal hypertension, leads to distension of veins around the stomach, that easily rupture causing severe blooding and blood loss in the gastrointestinal tract. In his case, there are two main possibilities. Severe gastritis (peptic ulcer disease) and ruptures veins due to portal hypertension.

A complete clinical review is compelling in this case. A endoscopic examination is needed to see the state of his stomach and duedenum, to ascertain if he has peptic ulcers and varices of not. Secondly, an abdominal ultrasound is required to appreciate the size and nature of the liver. Liver function tests like Transaminases are of utmost importance.

Other conditions that could lead to low iron saturation levels and low white blood cells should however be borne in min during the evaluation process. Malignancies, kidney disease must be carefully considered. Serum Vitamin B12 levels need to be measured to ascertain whether he needs supplementation or not.

Alcohol withdrawal techniques must be carefully considered in his case. This should be tackled with much tact and the services of a psychiatrist could be very helpful.

Book an appointment with the closest gastroenterologist. Thanks and hope this helps as I wish him the best of health. Kind regards.

Bain LE, MD.
Above answer was peer-reviewed by
Follow-up: Complaining of aches and pains. HIV and Hep C negative. Consumes alcohol. WBC and iron level are low. Suggestion? 25 hours later
The problem with vomiting blood and transfusions was about four months ago. He has been sober for two months. Would low white blood cell count persist to this point? I wonder about some auto-immune condition causing his pain deep in the shoulder and the low white blood cell count. What followup tests might be helpful in this regard. Complete blood count was done, and only abnormal readings were noted. What might be done to understand the anemia and low iron?
Answered by Dr. Luchuo Engelbert Bain 14 minutes later
Hi and thanks for the query,

A thin blood film shall give the exact images of the red blood cells, sizes and shapes. Depending on these, specific causes can be suspected. Secondly, a bone marrow biopsy could be useful in excluding some rare leukemias (bone marrow malignancy), that could characterize themselves with anemia and low white blood cell counts due to cell overcrowding. Transfusion history, persistent low white blood cell levels and anemia, could warrant the opinion of a hematologist.

He needs a complete clinical review. Book an appointment with a hematologist to evaluate and investigate these persistently low hematological parameters. He still however needs a complete clinical review by an internist or gastroenterologist.

Thanks and hope this helps. Feel free asking further questions if need be. Kind regards.

Bain LE, MD.
Above answer was peer-reviewed by
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