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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diabetes. Got done with RBC, CBC and neutrophil count. Should i see to a hematologist?

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Dr. Robert Galamaga

Oncologist

Practicing since :2002

Answered : 2617 Questions

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Posted on Thu, 27 Dec 2012 in Blood Disorders
Question: One year ago I had a low MPV 7.1 on routine CBC as I was feeling particularly tired and dizzy much if the time. just recently I had another CBC and MPV returned at 5.7 with low end but normal RBC. I was recently ( May 2012) dxed with Diabetes 1.5 and I have a long history of MS. MY only new medicatin is Glumetza for the Diabetes. Also neutrophil count is slighly low and eosonophil count is slightly high. I am lretty concerned about these numbers but more so the debilitating symptoms aof fatiguemand dizzyness and XXXXXXX brain fog" with weakness. MY PCP tells me that everything is fine but ai do not feel fine. Should I pursue with a Hematologist?
doctor
Answered by Dr. Robert Galamaga 18 hours later
Hello and thanks for your query.

I agree with your primary physician. Based on your blood test results I am confident that you do not have a hematological disorder. A fluctuation on neutrophil or eosinophil count is relatively common and does not automatically indicate a worrisome process.

I suspect your symptoms may be multifactorial.

I would suggest a comprehensive consultation as well as evaluation of your thyroid gland function. A full asseawmt by a nutritionist and a personal trainer may be beneficial as well.

An integral aspect of optimal health for you certainly includes an exercise regimen of 30-45 minutes 4-5 days per week.

Lastly, medications may cause a fluctuation in blood counts as well.

Again I want to reassure you that it is not likely at all that you have a blood disorder so I think seeing a hematologist is not necessary but if you would like additional reassurance I understand why you still would prefer such a consultation.

Thanks again for the query. Please let me know if you hav any additional concerns that you would like to discuss.

Sincerely,

Dr Galamaga
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Robert Galamaga 18 minutes later
Thank you. My problem is that I can barely manage my Adls due to overhelming fatigue and inability to concentrate. I had to give up my personal trainer because of tthe disabling fatigue.

Rbc, Hematocrit and Hemogloben have all dropped to lowest normal range since last test in July and you did not really address my biggest concern which is a drop in MPV from 7.1 to 5.7. Why would that be and could this too becausing my debilating fatigue and night sweats ?

Thank you again, XXXXXXX
doctor
Answered by Dr. Robert Galamaga 14 hours later
If the MPV on your CBC refers to mean platelet volume as it does on most CBC results then there is no reason why it could explain fatigue and night sweats.

Inflammation could cause this. Has your doctor checked LDH, sedimentation rate or CRP levels? If these are elevated it could signal a background level of inflammation which could potentially contribute to fatigue. Also viruses such as EBV could cause this - another thing which could be checked via a blood test.

Let me know your thoughts.

Dr G
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Robert Galamaga 9 hours later
Thanks so much Dr G for returning my quieries. Your consideration of generalized inflammation strikes me as sound. I would like to pursue it. I have an appointment on Friday wit my PCP and,in advance of this, she has ordered blood work for today. I hope that she has ordered some of the tests you suggested but I have no way of knowing that or really asking.

Indeed I had a very bad virus before current fatigue and dizzy/ ligtheaded symptoms and confusion emerged. The virus mostly went away with some lingering sore thoat an tended neck glands which I why I asked for the blood work.

It would not surprise me if a chronically high viral load would lead to problems in blood counts but I am not seeing thisnin my searches. This does seem like some kind of post viral or chronic fatigue syndrome but I must admit that the lowish rbc, crit, hemogloblen and very mean low mean platelet volume( normal platelets at 325) and white cell changes through me off. My last question being- do you see such changes in chronic fatigue related to viruses?
Thank you for taking the time to review my situation!!! XXXXXXX

doctor
Answered by Dr. Robert Galamaga 40 minutes later
Hello again,

While not common it is certainly possible that a post-viral syndrome could contribute to fatigue. This possibility warrants a workup to essentially rule it out. Your case is somewhat unusual and may take some more time to fully establish a causative factor of the symptoms you are having.

Please maintain an optimistic view as this type of thinking can only serve you well. Also, please try an maintain as active a lifestyle as possible with some exercise daily.

Lastly, I would ask your neurologist is this could be related to the MS or the MS medication which you are currently using.

Thanbks again for sharing your health concerns with me. I am available of course for further discussion in the future.

Sincerely,

Dr. Robert
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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