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Suggest treatment for low WBC and platelet count

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Pathologist and Microbiologist
Practicing since : 2003
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I am diabetic with portal hypertension. Taking medicine for hypertension - pantocid 20mg and Inderal 10mg twice Daily. For diabetes I am taking insulin 10 points and citapin XR 500 twice daily. I am anaemic and my blood count WBC and platelet count is very low. What I should do...
Posted Mon, 25 Aug 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Jyothi B L 13 minutes later
Brief Answer:
Attach reports, Reticulocyte count test required

Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.

Based on your reports, it appears to be pancytopenia. As all the three cell lines are reduced, and indicates defect at level of bone marrow.

I will require you to attach the complete hemogram or blood count reports (to assess the seriousness of pancytopenia), and if additionally any Vit B12 or folic acid studies done (they are routine nutritional causes). If you can get a reticulocyte count done, it will be easy to assess the functioning of bone marrow at present.

It appears to be secondary to Vit B12 deficiency due to possible alcohol induced (if you been drinking) malnutrition. You need to take specifically Vit B12 and folic acid supplements along with wholesome improvement in nutrition.
After 2 weeks of start of treatment, repeat reticulocyte count needs to done to check bone marrow response.

If more details are available, I can comment more clearly and more in detail.

Any further queries, happy to help again.

Dr. Jyothi BL
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for low WBC and platelet count 32 minutes later
Hi dr. My case pancytopenia due to hypersplenism secondary to portal cein thrumbosis. My 2010 reports done by haematogist with bone marrow examination " marrow is consist with hypersplenism. inadequate iron stores". Sine then i am taking Softeron Z, Nuroday, Folinine. But my cbc report shows Haemglobin - 10.5, RBC count 3.97, PCV 33.1 , WBC 2700, Platelet 67000. Month on month this remains same with slight up with Haemoglobin and vice versa.
 
 
Answered by Dr. Jyothi B L 2 hours later
Brief Answer:
Pancytopenia, possibly not due to hypersplenism

Detailed Answer:
Hi,
Thanks for asking.
Portal vein thrombosis has led to hypersplenism. This hypersplenism possibly could not have led to pancytopenia.
If there was no portal vein thrombosis, pancytopenia could have been due to hypersplenism. Another cause of pancytopenia needs to be identified.

The bone marrow examination is consistent with hypersplenism (It can be normal or slightly increased bone marrow response), which means it is normal and bone marrow function was normal at that time, except for reduced iron stores.

Looking at the various values, I would think you might be having nutritional deficiency. Possible cause could be diabetes mellitus, leading onto malabsorption.
Injections might be necessary.
You need to check for ferritin, total iron binding capacity and serum Vit B12 and Folic acid levels. I expect, at least Vit B12 levels to be abnormal.

Also get a reticulocyte count done, to look for bone marrow condition.

Any further queries, happy to help again.
Dr. Jyothi BL
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for low WBC and platelet count 2 hours later
Thans Dr. I will do the test and revert to you. I provide the brief medical history of mine. In 1993, i got married. After six month of marriage i had backacke problem. I was not regular in my eating and drinking water. I was workohlic. For one year Dr did various blood test and Spine MRI but not able to dignosis anything. Then i had mild fever in evevning which normalise after profuse sweating in night. i lost 20 kg weight. Then i had drawing pain in stomach if i am empty stomach and it get settle after eating. After eating i had feeling of not able to hold my stomach without hand support that ends with backache. In sonography of stomach nothing abnormal found my spleen was enlarged and MRI was showing gap in lower midle lumbers. I was hospitalised while passing XXXXXXX In colour dopler they found one gland size of half inch on portal vein. They did liver bypsy and TB gland. I was discharged from hospital after 15 days with dignosis " TB in liver, portal vein thrumbosis, 3rd grade variasis on usaphagus" why it has happened not known. In 2001 i felt i had passed red blood (few drops) in stool. Dr did protoscopy in anus found no sign of bleeding from lower side however found marks of having varisis in that region but now normal with thick wall of skin. Then Dr. did endoscopy they found 3 variasis in usafagus and did bending of two varisis in two sitting. However Dr was sure that none of the variasis were bleeded. One variasis was " Govi" variasis which i refused to treat due to pain in thoat and backacke. Dr. Prescribed me Pantocid 20 mg and Inderal 10mg medicine in morning for life. In 2005 due to acidity and little migran Dr. recommanded the above medicine twice daily for life. In 2007, i dignosised diabetes Dr. Gave me Cetapin XR 500 mg. Within six month i had complained of vocal fatique and air hunger. My vocal cord has phonatary gap of 1/2mm. I did vocal excercise and got little improvement but my voice texture has changed. Now i had a problem of Adductor Spasmodic Dysphonia. I refused botox injection treatment and follwing vocal excercise regularly. I am 52 yrs old, weight 91 kgs, daily doing 20 min walking, 30 min yoga, 20 min pranayam. I eat very lillte in morning breakfast as not feeling hungry. In afternoon also two chappati and vegitable/dal and salad. But in dinner i overeat as very hungry and i keep eating atleast 2 hours. Then i go for 20 min walk and then sleep 6-7 hours. After start of insulin treatment i have stopped eating sweet in night otherwise i could not resist sweet in night (which i hate in day time).
 
 
Answered by Dr. Jyothi B L 15 hours later
Brief Answer:
Will wait for report.

Detailed Answer:
Hi,
Do get back with report. Try to loose weight also.

Dr. Jyothi BL
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for low WBC and platelet count 2 days later
Good morning Dr. I have done my all test reports are summarised below:
Reticulocyte count 0.8%,
S. Iron: 44.2, TIBC 380.1, UIBC 335.90, %Saturation 11.63 (low).
Folic Acid: above 20.0
FERRITIN: 35.6
Serum B12: 1561 (high).
25 Hydroxy (OH) Vit D: 38.9
HbA1C: 8(high), eAG (new) 182.9 and MPG (old) 207.5
CBC: Haemoglobin 11.4, PCV 34.7 (low), Platelet count 76 (low), WBC count 3(low) report attched: CBC, Lipid profile, Biochemical test, Urine Report.
 
 
Answered by Dr. Jyothi B L 10 hours later
Brief Answer:
Require previous Serum Vit B12 levels reports

Detailed Answer:
Hi,
Thanks for replying with reports.
However, one of the reports is missing which shows iron values, serum B12 etc.

I have primarily one query. Was your serum B12 always this high? Can you look at your previous reports of last 14 years, if any to confirm it.
You liver function is normal. I need to rule out other things which can be associated with high serum vit B12. Before I say anything, i might require a confirmation.

It appears there is a possibility of urinary tract infection, culture and sensitivity might be necessary. Discuss with your doctor regarding treatment for urinary tract infection.
I need to know more about about your previous serum Vit B12 levels. I am worried about Serum Vit B12 levels as there might be underlying disorder contributing to pancytopenia.

Dr. Jyothi BL
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for low WBC and platelet count 1 hour later
Please find attached S.Iron and S. B-12 reports. I have check my earlier on Vit B 12 in july 2008 it was 211 and aug 2010 it was 434. In July 2008 i had Vocal problem and Dr. did all test for mysthenia gravis but found all test were normal so he prescribed vit b12 to me which i took for 6 month. Then from aug 2010 Dr. prescribed "Neuroday tablet" and since then i am taking this tablet.
 
 
Answered by Dr. Jyothi B L 1 hour later
Brief Answer:
further evaluation for raised Vit B12 important.

Detailed Answer:
Hi,
Thanks for the reports.
Your reticulocyte count is within normal range, indicating no hemolysis. Hypersplenism or splenomegaly is not responsible for your pancytopenia.

The raised serum Vit B12 is the only abnormal finding. For further evaluation peripheral smear for immature cells or bone marrow biopsy is necessary. I do not want to alarm you, but I find raised B12, a significant finding. It can get raised in liver pathologies, renal pathologies and hematological diseases including cancers of the above organs.
As at present, you have pancytopenia, I would advise you to get a peripheral smear and a bone marrow evaluation done. Do discuss with your doctor. Recent studies are using elevated Serum Vit B12 as a marker for cancer.

Further evaluation is necessary. If the bone marrow and peripheral smear are normal, ultrasound abdomen might be necessary to look for any lesions. If you have any other symptom other than previously told, it could point towards a diagnosis. Do discuss with your doctor.

Hope it helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Above answer was peer-reviewed by
 
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