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Dr. Andrew Rynne

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Have LBP, feeling lethargic and lightheaded. CBC test done. What does the reports says?

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Dr. Akhilesh Dubey

Internal Medicine Specialist

Practicing since :1986

Answered : 2094 Questions

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Posted on Sat, 22 Dec 2012 in X-ray, Lab tests and Scans
Question: Hi, I am a 42 year old female. Have discovered that I have low blood pressure (usually around 90/52, but has been as low as 84/47). Sometimes I feel lethargic and lightheaded. Had CBC - results were: Haemoglobin 116 (120 - 3 months prior), RBC 3.86 , (3.93 - 3 months prior), HCT 0.36 (0.37 - 3 months prior), , MCV 93, Platelets 158 (192 - 3 months prior), WBC 4.3 (5.4 - 3 months prior), Neutrophils 2.56 (3.63 - 3 months prior), Lymphocytes 1.30 (1.26 - 3 months prior), Monocytes 0.33 (0.38 - 3 months prior), Eosinophils 0.09 and Basophils 0.01. Also, eGFR=85 (81 - 3 months prior), HbA1c 38 (35 - 3 months prior), Ferritin 42 (59 - 3 months prior), and Serum B12 and Serum Flotate are fine.Cholestorel and Liver Function Tests are normal. TSH is 1.3 (1.9 - 10 months prior). Sodium, Potassium and Creatinine, Calcium and Albumin are normal. I have a slender to average weight, exercise a few times a week, eat healthily (gave up meat about 6 months ago, but still eat fish, have nuts, legumes, dairy, vegetables, fruit, 8 x glasses water day). I'm concerned the combination of low blood pressure and low hemoglobin might cause damage to organs due to lack of oxygen over a period of time. Do you know what might be the likely causes of my low blood pressure, low hemoglobin and borderline high blood sugar?
doctor
Answered by Dr. Akhilesh Dubey 1 hour later
Hi,

Thanks for your query.

You are having two health issues:
1) Low blood Pressure 2) Slightly low Hemoglobin

Low blood pressure (Hypotension) if significant, we need to know the cause.

I would like to know
1.     Are these reading are self monitored?
2.     D o you get dizziness or black out and fall down?
3.     Do you have any blood loss which may be cause of Anemia?

In hypotension B.P. reading in supine, sitting and standing position has to be noted.
It may be associated with Postural hypotension, postprandial hypotension, neurogenic hypotension, some disorders like Addisons disease, even Diabetes.

I have gone through all your investigations. They are fine. In your case there is borderline anemia and you are taking care of diet and exercise.

Please continue to take more salt and water, as it keeps blood volume, and helps to maintain blood pressure. Please do not worry a little drop in Hemoglobin. It will not cause any organ damage.

What is the level of blood sugar? It should be taken care by diet and exercise and periodic checkups.

Please reply with details asked in particular, so that, I can clarify a bit more.

Hope this information will help you.

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Akhilesh Dubey 13 hours later
Dear Dr. Dubey,

Thank you for your reply. My HbA1c is 38, which is about 5.7%. I find this strange since I do not eat much junk or high-surgar foods - I have a very healthy diet and exercise. I am 5 ft 2 inches and 51kg, so a healthy weight. The blood pressure readings are both self-monitored and also similar to readings at the doctors, and also at a nutritionist I visited a little while ago. I do not faint or black out, just feel light-headed, fatigued and not quite with it at times. The blood reading is when I am sitting down. Should I take it lying down and standing and send these to you? I have been eating quite a lot of salt and it there hasn't been any improvement in my blood pressure. I have always drank 8+ glasses of water a day. Could the combination of low hemoglobin and low blood pressure (the combination of these together) affect my organs if they continue long-term?

I do not have any blood loss that I am aware of that would cause the mild anemia. My periods are not overly heavy and the last blood test was about three weeks after my previous period. Also, my iron levels etc are ok. My platelet count decreased quite a lot in the three months (192 to 158), so I'm not sure if that is related?

Kind Regards
XXXXXXX
doctor
Answered by Dr. Akhilesh Dubey 8 hours later
Hi,

Thanks for your input,

Your HbA1c level is fine at 5.7%. Just keep a watch on your sugar level so as to detect early if they go high.

Yes. Please record your BP in supine and standing position keeping instrument at the level of heart and let me know the readings.

Sometime, blood loss is not visible and we need to check occult blood in stool and urine.
If you keep a lower BP and it is not symptomatic, it may be normal for you, but if it is troublesome then, you may consider visiting Physician and search for cause.

Your platelets are still in normal range and they can be rechecked after month or so. Whether it is related to low hemoglobin level will have to be investigated. As said before, your hemoglobin levels are fine, and cannot cause any problems for any organs. At the same time, if blood pressure falls too low, with symptoms, it can cause damage to certain organs like, brain and kidneys.

You have healthy weight so do not worry.

I hope this information helps you, please inform your BP readings.

Regards.

Above answer was peer-reviewed by : Dr. Mohammed Kappan
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