Question: Hello:

I was diagnosed in late January with CIDP which I believe came on following a flu shot in November (within 2 weeks). Prior to the CIDP onset, I had just went through 6 months of figuring out that my memory fog and other issues were likely due to mild anemia caused by uterine fibroids (heavy cycles and lacto-ovo vegetarian diet).

With dietary changes, my levels got better and were screened in Fall 2014. I was in the clear, it appeared.

Now, with the CIDP, I am getting monthly IVIG treatments (50 mg) but I having mental energy issues again (looks more like anemia than the disease). Physically, I am about 80-90% of my former strength and endurance on a daily basis. I know it wears on me as it is active.

That said, I continue to supplement and have further improved iron intake with fish introduction 3 months ago (with the diagnosis). My fibroids are still there and I still have heavy cycles. I have other side effects and I plan to have a hysterectomy (da vinci) over the December holidays. I just can't do it now due to missed work.

That said, I am perplexed by my bloodwork and fear that the anemia is more of a different kind that iron deficiency (maybe driven by lack of production or destruction of blood cells than iron deficiency from blood loss). It feels like my situation should be getting better if the cycles remain constant and I continue to supplement. I am also looking at my MCV result.

I am also worried about blood thickness/clotting from CIDP treatment with IVIG over time. My blood pressure continues to be ok though. Is there a blood test I should run to check this periodically with my neurologist? (serum osmolality) or is blood pressure monitoring ok.

I was told by my md that I still have anemia (no other input) and to take down my B12 supplementation, which I see. Also, the high protein and other indicators show the disease (inflammation) in effect.

I get headaches throughout the month that I know can be caused by IVIG, but they come and go. I get them immediately following which is expected, but the spuratic ones are new and not something I experienced before the CIDP diagnosis (maybe unrelated and just IVIG, not anemia).

Do I have reason to see a hematologist or does this look like typical anemia due to blood loss?

Here is some of my recent bloodwork:
Range/ my results

Blood Urea Nitrogen     10 - 25 mg/dL/      7

PROTEIN TOTAL     6.4 - 8.2 g/dL/     8.9
Albumin     3.7 - 4.8 g/dL/     3.5
Globulin     2.5 - 4.1 g/dL/     5.4
A/G Ratio     0.9 - 1.8/     0.6

Reticulocyte count or ferritin- not taken
     
Signs inflammation w/ (CIDP)
B12 at 932

Component     Standard Range     Your Value
WBC Count     3.8 - 10.6 K/uL      / 4.2
RBC Count     4.15 - 5.55 M/uL/     3.78
HEMOGLOBIN     12.0 - 15.0 g/dL/     11.1
HEMATOCRIT     36 - 46 %     /33.8
MCV- size     80 - 100 fl/     89.4
MCH (Amount)     26 - 34 pg/     29.5
MCHC     31 - 37 g/dL/     32.8
RDW (blood cell size)     <14.5 %/     13.3
PLATELET COUNT     150 - 450 K/uL/     279
Bilirubin, Total     <1.2 mg/dL/     0.8

Component Results
Component     Standard Range     Your Value
Iron     50 - 170 ug/dL     / 86
Iron Binding, Total     250 - 450 ug/dL/     363
Iron Saturation     15 - 50 %     / 24

Thyroid tested:
TSH
Free T3
Free T4
All in Normal Range

Vitamin D in normal range

Thank you for the review.

I will request these tests. Should I follow up initially with my MD for the reticulocyte test, etc. or is it best to see a hematologist at this point?

Given my CIDP diagnosis, it could be hemolysis from autoimmune condition (saw that this was rare), but I realized there are other options and diagnostics are required. Is that treatable, beyond treating CIDP with IVIG and supplementing? I am already doing this for some months and while additional nerve damage has been stopped and my muscles have returned most strength, it seems my RBC is getting worse, not better. Would I have other options to control such a condition (if this is what it is) from worsening?

Thanks again.