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What causes autoimmune hemolytic anemias?

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Posted on Mon, 18 May 2015
Question: Hello. I am a 31-year-old patient with a history of rheumatoid arthritis, lupus, celiac disease, sjogren's syndrome, chiari malformation, and more. I have been on rituxan, methotrexate, and a number of other DMARDs and biologic drugs. (Currently, Enbrel, but have tried many more.) Lately, I've been feeling exceptionally rundown, with widespread, deep bone pain. Not isolated to joints, but, rather, a deep-set flu-like ache. Also, tachycardia, chest and abdominal discomfort, headaches, bruising, and more, plus lightheaded/feeling like I'm going to pass out. Brain MRI was normal. Awaiting echocardiogram results. However, recent blood tests showed 2 abnormalities. My MPV was 11.8 and my B12 was >2000. I have left a message for my rheumatologist to return my call. I am a level-headed, educated person who is not a worrywart and does not "freak out" over things like this. I am unfortunately educated enough to realize, however, that this could indicate liver issue OR leukemia, is that correct? What other tests would you suggest be run to look for leukemia? Am I correct that this is a possibility, however distant? Or should I not be at all concerned. I'd rather know than not know, and am in the "better safe than sorry" school of thought. Thank you!
doctor
Answered by Dr. Shruti Rijhwani (9 hours later)
Brief Answer:
Needs evaluation further.

Detailed Answer:
Dear madam,

Thank you for posting your query on HCM.

Well looking into your problem I would like to tell you that please send me your entire blood test reports . It will be difficult to comment on the reports that you have sent as they can be very non specific plus you need not worry about leukemia and liver issues as in that case other tests will also show abnormalities like cbc , lft etc.

Even lupus activity can give rise to all your issues and it needs to be determined whether its the underlying disease that troubles you or something else is going on .

So please upload your reports so that we can understand your position better. Any other concerns feel free to ask .

Take care.

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shruti Rijhwani (22 minutes later)
All other lab values were negative/normal ... would you still like to see the full reports? Also, MPV I can see relating to lupus, but could you explain how B12 over 2000 would be related to autoimmune or rheumatic illness? Thank you!
doctor
Answered by Dr. Shruti Rijhwani (11 hours later)
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thanks for reverting back.

Sometimes in autoimmune hemolytic anemias due to destruction of red blood cells vitamin B12 levels can be increased but it needs to be seen in whole scenario . Yes I would like to see your all test reports as to what were done.

Have you taken any vitamin B supplement earlier ? plus I would like to see the peripheral smear report also if they have reported any atypical cells .

Dr. Shruti

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shruti Rijhwani (3 days later)
I included a note. I'm trying to get the report in a PDF file from Doctor's Office. My concern is P Vera or CML. Thoughts?
doctor
Answered by Dr. Shruti Rijhwani (9 hours later)
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thank you for reverting back.

Well looking at the reports that you have sent I dont think there exist a possibility of either Polycythemia vera or CML. Polycythemia vera patient will have high Hemoglobin and CML patient will have high TLC counts primarily which is not present in your case so I dont see a possibility for the same anyhow .

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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What causes autoimmune hemolytic anemias?

Brief Answer: Needs evaluation further. Detailed Answer: Dear madam, Thank you for posting your query on HCM. Well looking into your problem I would like to tell you that please send me your entire blood test reports . It will be difficult to comment on the reports that you have sent as they can be very non specific plus you need not worry about leukemia and liver issues as in that case other tests will also show abnormalities like cbc , lft etc. Even lupus activity can give rise to all your issues and it needs to be determined whether its the underlying disease that troubles you or something else is going on . So please upload your reports so that we can understand your position better. Any other concerns feel free to ask . Take care. Dr. Shruti