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From: Richard on 4 Apr 2008 16:56
I'm unsure where to post this, but my wife's CBCs have been getting
worse over the past 5 years. This year, her RBC is flagged low on each
test (with differential). She hasn't been diagnosed with lupus or
anything else but I thought you all might be knowledgeable about this.

Her PCP keeps saying that "it's just a little low, nothing to worry
about" but this just keeps getting lower each time she checks it.

She has a low RBC, lowish WBC, lowish hemoglobin, lowish hematocrit,
and lowish RDW, low-norm platelets, everything else was normal: MCV,
MCH, Neutrophils, etc.

WBC: 4.4 (ref 4 - 10.5)
RBC: 3.76 LOW (ref 3.8 - 5.1)
Hemoglobin: 12 (ref 11.5 - 15)
Hematocrit: 35.1 (ref 34 - 44)
MCV: 93 (ref 80 - 98)
MCH: 32 (ref 27 - 34)
RDW: 11.9 (ref 11.7 - 15)
Platelets: 166 (ref 140 - 415)
Neutrophils: 65 (ref 40 - 74)
Lymphs: 23 (ref 14 - 46)
Monocytes: 8 (ref 4 - 13)
Eos: 3 (ref 0 - 7)
Basos: 1 (ref 0 - 3)

Neutrophils Absolute: 2.9 (ref 1.8 - 7.8)
Lymphs Absolute: 1 (ref 0.7 - 4.5)
Monocytes Absolute: 0.4 (ref 0.1 - 1)
Eos Absolute: 0.1 (ref 0.0 - 0.4)
Baso Absolute: 0.0 (ref 0.0 - 0.2)

Any ideas? I'm cross posting to sci.med in case this is the wrong
group. Thanks for any ideas.
From: janers on 5 Apr 2008 00:40
Your wife's blood work doesn't look too bad really. My white counts are in the 3.8 range and my
red cells are very low as well. My rheumy says the same as her's does. it is low but ok range not
to worry.

So I don't try to dwell on it. If it was too bad I am sure your doctor would worry. But the norms
are in a good range even with it being low normal range. I gather you said they get lower with each
time, tis true for myself.Then all of a sudden they go up. WHY? have no clue.
But at least she is being monitored and that is great news too.

Just keep tabs and hope for the best. Tis what I do and have too.

Low red cells bother me because of anemia but if that happens the volumes change also as well as
hemoglobin and hematocrit. They weigh all them tests to decide anemia and what is causing it.
I would not worry too much

Is she on iron and or vitamins with high B complex? AND NO I AM NOT IRON JUSTICE LOL.

good for you to monitor and help your wife so much
janers


From: Robert1 on 5 Apr 2008 00:42
On Apr 4, 1:56 pm, Richard <sooperdoo...(a)cox.net> wrote:
> I'm unsure where to post this, but my wife's CBCs have been getting
> worse over the past 5 years. This year, her RBC is flagged low on each
> test (with differential). She hasn't been diagnosed with lupus or
> anything else but I thought you all might be knowledgeable about this.
>
> Her PCP keeps saying that "it's just a little low, nothing to worry
> about" but this just keeps getting lower each time she checks it.
>
> She has a low RBC, lowish WBC, lowish hemoglobin, lowish hematocrit,
> and lowish RDW, low-norm platelets, everything else was normal: MCV,
> MCH, Neutrophils, etc.
>
> WBC: 4.4 (ref 4 - 10.5)
> RBC: 3.76 LOW (ref 3.8 - 5.1)
> Hemoglobin: 12 (ref 11.5 - 15)
> Hematocrit: 35.1 (ref 34 - 44)
> MCV: 93  (ref 80 - 98)
> MCH: 32  (ref 27 - 34)
> RDW: 11.9 (ref 11.7 - 15)
> Platelets: 166 (ref 140 - 415)
> Neutrophils: 65 (ref 40 - 74)
> Lymphs: 23 (ref 14 - 46)
> Monocytes: 8 (ref 4 - 13)
> Eos: 3   (ref 0 - 7)
> Basos: 1 (ref 0 - 3)
>
> Neutrophils Absolute: 2.9 (ref 1.8 - 7.8)
> Lymphs Absolute: 1 (ref 0.7 - 4.5)
> Monocytes Absolute: 0.4 (ref 0.1 - 1)
> Eos Absolute: 0.1 (ref 0.0 - 0.4)
> Baso Absolute: 0.0 (ref 0.0 - 0.2)
>
> Any ideas? I'm cross posting to sci.med in case this is the wrong
> group. Thanks for any ideas.

You don't state your wife's age or any other medical conditions she
might have. In general folate deficiency is common as one gets older
as is B12 deficiency. With any chronic illness then there is also
anemia of chronic disease that one has to contend with. Thyroid
disorders also tends to occur with increasing age also along with
other primary bone marrow disorders and medications can also cause
anemia. Folate and B12 deficiencies can cause low white cell counts
and platelets. The RDW is normal and not elevated and so the cells are
fairly uniform in size. This tells me that the new red cells are not
elevated as the young cells are usually larger than the mature red
cells. Those that are bleeding or with hemolysis would tend to have a
higher production of those cells. The only sure way is to do a retic
count to see what the red cell production is. Here again a history of
bleeding or malabsorption problems like celiac disease is important.

She hasn't crossed the line into anemia as yet as it is defined by a
decreased hemoglobin or hematocrit, Once it does cross that line then
it can be further divided into those with decreased hemoglobin content
MCHC and red cell size MCV which can give clues in terms of origin.
With other counts decreasing then pancytopenia is something to keep an
eye on.

So the clinical context is important in knowing what's going on with
your wife and how to interpret the labs. A multi-vitamin is a safe
bet.
From: Richard on 5 Apr 2008 02:03
On Apr 4, 9:40 pm, "janers" <rojak...(a)bright.net> wrote:
> Your wife's  blood work doesn't look too bad really.  My white counts are in the 3.8 range and my
> red cells are very low as well.  My rheumy says the same as her's does. it is low but ok range  not
> to worry.
>
> So I don't try to dwell on it. If it was too bad I am sure your doctor would worry.  But the norms
> are in a good range even with it being low normal range.  I gather you said they get lower with each
> time, tis true for myself.Then all of a sudden they go up. WHY?  have no clue.
> But at least she is being monitored and that is great news too.
>
> Just keep tabs and hope for the best.  Tis what I do and have too.
>
> Low red cells bother me because of anemia but if that happens the volumes change also as well as
> hemoglobin and hematocrit. They weigh all them tests to decide anemia and what is causing it.
> I would not worry too much
>
> Is she on iron and or vitamins with high B complex?  AND NO I AM NOT IRON JUSTICE LOL.
>
> good for you to monitor and help your wife so much
> janers

Janers,

Thanks for the reply.. I got two replies, that's nice.

She takes truck loads of B vitamins because she has a thyroid issue (I
forgot to mention, but will in Robert's reply). She doesn't take a
multi vitamin but I'll ask her to!

Thanks,
Richard
From: Richard on 5 Apr 2008 02:13
On Apr 4, 9:42 pm, Robert1 <Goldentouch...(a)yahoo.com> wrote:
> On Apr 4, 1:56 pm, Richard <sooperdoo...(a)cox.net> wrote:
>
>
>
>
>
> > I'm unsure where to post this, but my wife's CBCs have been getting
> > worse over the past 5 years. This year, her RBC is flagged low on each
> > test (with differential). She hasn't been diagnosed with lupus or
> > anything else but I thought you all might be knowledgeable about this.
>
> > Her PCP keeps saying that "it's just a little low, nothing to worry
> > about" but this just keeps getting lower each time she checks it.
>
> > She has a low RBC, lowish WBC, lowish hemoglobin, lowish hematocrit,
> > and lowish RDW, low-norm platelets, everything else was normal: MCV,
> > MCH, Neutrophils, etc.
>
> > WBC: 4.4 (ref 4 - 10.5)
> > RBC: 3.76 LOW (ref 3.8 - 5.1)
> > Hemoglobin: 12 (ref 11.5 - 15)
> > Hematocrit: 35.1 (ref 34 - 44)
> > MCV: 93  (ref 80 - 98)
> > MCH: 32  (ref 27 - 34)
> > RDW: 11.9 (ref 11.7 - 15)
> > Platelets: 166 (ref 140 - 415)
> > Neutrophils: 65 (ref 40 - 74)
> > Lymphs: 23 (ref 14 - 46)
> > Monocytes: 8 (ref 4 - 13)
> > Eos: 3   (ref 0 - 7)
> > Basos: 1 (ref 0 - 3)
>
> > Neutrophils Absolute: 2.9 (ref 1.8 - 7.8)
> > Lymphs Absolute: 1 (ref 0.7 - 4.5)
> > Monocytes Absolute: 0.4 (ref 0.1 - 1)
> > Eos Absolute: 0.1 (ref 0.0 - 0.4)
> > Baso Absolute: 0.0 (ref 0.0 - 0.2)
>
> > Any ideas? I'm cross posting to sci.med in case this is the wrong
> > group. Thanks for any ideas.
>
> You don't state your wife's age or any other medical conditions she
> might have. In general folate deficiency is common as one gets older
> as is B12 deficiency.

My bad! She is 31 years old and she does have hashimoto's thyroiditis,
and she takes Armour for that. She doesn't have any other conditions
though. She did have a blood test for B12 and folate, both of which
were right in the middle of the reference range. I don't know what
ferritin was but serum iron was 78 (ref 35 - 155) :-(

> With any chronic illness then there is also
> anemia of chronic disease that one has to contend with. Thyroid
> disorders also tends to occur with increasing age also along with
> other primary bone marrow disorders and medications can also cause
> anemia. Folate and B12 deficiencies can cause low white cell counts
> and platelets. The RDW is normal and not elevated and so the cells are
> fairly uniform in size. This tells me that the new red cells are not
> elevated as the young cells are usually larger than the mature red
> cells. Those that are bleeding or with hemolysis would tend to have a
> higher production of those cells. The only sure way is to do a retic
> count to see what the red cell production is. Here again a history of
> bleeding or malabsorption problems like celiac disease is important.

One doctor said that she might have endometriosis, because she bleeds
rectally during her menstrual.. Again, her PCP and OBGYN both ignore
this problem. One other thing, she was born with thymus hypoplasia but
her immune system is "ok" according to the PCP. Oh one other thing,
her blood pressure has always be really low, like 90/60!

> She hasn't crossed the line into anemia as yet as it is defined by a
> decreased hemoglobin or hematocrit, Once it does cross that line then
> it can be further divided into those with decreased hemoglobin content
> MCHC and red cell size MCV which can give clues in terms of origin.
> With other counts decreasing then pancytopenia is something to keep an
> eye on.

Shoot, pancytopenia is scary.

> So the clinical context is important in knowing what's going on with
> your wife and how to interpret the labs. A multi-vitamin is a safe
> bet.- Hide quoted text -

She's going to try a multi-vitamin. I hope its not pancytopenia. Maybe
because she has hashi's, she might have auto-immune aplastic anemia?
hope not!

Thanks,
Richard

> - Show quoted text -

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