Help interpreting my FBC results please

Hello everybody,

I first would like to give thanks to the creators of this forum.  It is a great place, and provides a great service to all those who find themselves insecure and worried about their conditions.

I have recently had an FBC done as i was worried about lymphacytosis which in turn, turned out negative.  On the other hand, it brought to my attention my Beta Thalassemia Trait.  I have been to see my doctor about constant tiredness and thought it may be my thyroid, as my dad has hypothyroid, but this turned out negative.  My doctor never mentioned anything about my thalassemia contributing to this.  Its only after researching this myself, that i have found that it could be due to this.

I find myself needing regular sleep, not being able to concentrate for long periods of time, being zombified infront of the tv staring through it, not going out and socialising, avoiding social events due to lack of enthusiasm, and general moodyness and lack of motivation.  I have even tried thermogens recently to perk me up, but they have no affect. 

My blood results are:

ESR --------------------  7 mm/hr              2 - 12
Haemoglobin--------  12.9 g/dl              12.5 - 17.5
Haemotocrit --------  0.39 l/l                 0.40 -0.52
RBC -------------------  6.87                    4.5 - 6.5
MCV ------------------  57.4 fl                  77 - 96
MCH ------------------ 18.8 pg                27 - 32
MCHC-----------------  32.7 g/dl              31 - 35
Platelets -------------- 345                     150 - 400
White Blood Cells--- 5.8   10^3/ul        4.0 - 11.0
Neutrophils----------- 2.59  10^3/ul       2.0 - 7.50
Lymphocytes ------- 2.38   10^3/ul       1.50 - 4.00
Monocytes ---------  0.72   10^3/ul       0.00 - 0.8
Eosinophils----------- 0.05   10^3/ul       0.00 - 0.45
Basophils-------------- 0.04   10^3/ul      0.00 - 0.2

TO SUM UP, HB AND HAEMOTOCRIT, SLIGHTLY OUT OF RANGE.  RBC SLIGHTLY ABOVE. MCV/MCH WELL BELOW.

I had 2 blood FBCs done recently.  One with my GP and the other done privately.  My NHS GP, had different safe values for HB.  They were 13-17.5, so my 12.9 was just out of range.  The results i have posted were from a private doctors, whos lab had different safe values which were 12.5 - 17.5.  Either way, my HB is on the low end of the scale, but not perticularly low as others on this forum.

This gets me worried, as i feel very very tired.  Its got me worried that it is something else wrong with me, but i dont know what to do.  My MCV and MCH are very low.  Would this cause tiredness?  I am 26, 6ft, and 87kg.  I am quite big, so i would assume that having low blood oxygen levels would be a problem for me as i have a large body mass that would need good circulation.

Do my blood results show anything that would imply reasons for tiredness?  Even now, i want to go and lay down, and probably will after i finish this message.  I am partly depressed about this too, which could be contributing, and i am not very motivated for anything.  I have been taking 1.6mg folic acid and 1mg b12 for 4 days now, but feel no difference at all.  I have tried going through exercise regimes and very good eating habits and this only help a small amount.  I have been feeling tired for very many years now, and even looking back at school days, i used to come home and take a nap from 4-6pm ish.  Its got sloowly worse over the years since then.  As it has been for at least 10 years now (probably more) and nothing perticularly serious has happened to me (apart from it slowly getting worse) and as im growing, it leads me to believe that it could very well be to do with the thalassemia trait.

Can anyone suggest any blood tests i should ask for?  I am thinking of going to my doctors tomorrow, but i dread it, as i have been to see him for a lot of things recenlty and i think he is starting to write off a lot of what i say as hypochondria.  I have no idea what my iron levels are like, but i eat lots of fruit, vegetables and red meat.  I have always had ridiculous cravings for lemon.  It goes on everything.  I have pretty weak joints that get very painful with exercise.  Hands hurt if i lift weights, or hang from a bar for chin-ups or monkey bars etc..  My neck hurts if i look down at my sketchpad for a while.  I tried to learn guitar, but my neck would hurt looking at the frets for too long.

I am really stuck and need some information.  Any would be greatly appreciated.  If i have missed something out, i will try and add it in, but i have also put some of my symptoms at the bottom of another thread here:

http://www.thalassemiapatientsandfriends.com/index.php?topic=1817.0

Again, thanks for your precious time spent reading this.

Btw, if ever im bleeding, i can TOTALLY smell the iron.  I dont know if thats a perticularly accurate method, but it does smell pretty strong. 

Hi,

> ESR --------------------  7 mm/hr              2 - 12
Although it seems not elevated, you must bear in mind that ESR in people with microcytosis is usually lower than it should be considering their inflammation status. So 7 may translate easily to above 12 as you have quite severe microcytosis (MCV very low). I never get my ESR result above 1 mm, and I have microcytosis too.

http://www.medal.org/visitor/www%5CActive%5Cch3%5Cch3.01%5Cch3.01.03.aspx

In order to evaluate your inflammation I would recommend doing CRP.

You write the other thread:
> I would say i have high acidity, because i eat lots and lots of lemons,
> vinegar, pickles, etc.. and have very obvious acid erosion on my teeth.
> I eat alot of dairy and meat ( and fruit and veg and nuts ).
Actually lemons alkalize your body. Although acid in taste they are processed in the liver to alkalic compounds. All the other things, especially dairy and meat cause acidity, and they increase production of uric acid. So the next recommended test would be uric acid (in blood and then in 24 urine collection). I would say that joint pains may be due to high uric acid. And you may have these lemon cravings, because this is the only thing that helps you. You just feel better when you eat it and the body is quick to learn such dependencies.
Your description of joint pains and neck and that it hurts to lift something is exactly what was happening to me.
Of course these joint pains may be also a beginning of rheumatoid disorders, but let's not jump to conclusions.

Your MCV is very low, but hemoglobin level is high and RBC is high. My results look the same, although the actual values are somewhat different. What does this mean?
Very low MCV (V = volume) means that red blood cells break before they can grow enogh and become normal grown blood cells and have normal volume. Normally this would mean hypoxia (lack of oxygen) for you tissues. In order to compensate for this bone marrow produces lots and lots of red blood cells, so your RBC result is higher than normal and your hemoglobin is not that low.
How hard does the bone marrow have to work in order to compensate?
I'm not sure, but 2-3 times harder than usual for sure. Can you imagine blood donors giving 6 units of blood instead of 2 per month? They would be completely exhausted, and no hematologist would ever allow something like this. However they allow this in beta thal minors. At such a rate of production of red blood cells all vitamins and nutrients are very quickly depleted (once used they can't be recovered), so you are suffering from chronic vitamin deficiency.
So as I said in the other thread multivitamin and gin-seng should help, without doing any fancy testing. Antioxidants like wheatgrass, vitamin E, even L-carnitine have direct impact and help survive red blood cells for a little longer. Puritan's iron-free multivitamin (link that I provided in the other post) is a multivitamin of choice, because it does not contain iron. You probably do not iron because you have high hemoglobin, and this means that you should avoid iron. But to be sure, you may order free iron, TIBC and ferritin. These have to be done at the same time to have a full picture.
The only vitamin, that you should test for is vitamin D, because if you are deficient, you will need to take high doses of this vitamin, which could be harmful if you are not deficient.
But remember, the doctor will not be listening to what you have to say, so I doubt that he will order vitamin D test, as it is quite expensive and done almost exclusively for older people who have ostheoporosis.

OK, these were basics, so maybe we'll wait for these tests and we'll pick up from there...

B.

The ESR reading has got me extremely worried   At one point, my liver enzymes were ever so slightly high, and i got Hepatitus tests done, which all came back negative.  Now im worried about tumours!   I dont know what to do, and my doctors didnt think the ESR was of any concern.  Do you think i should bring this to my doctors attention again?

As far as I know ESR has got nothing to do with tumours. It is only a sign of inflammation caused by infection or inflamatory diseases (and gout is one of them - you have inflammation in your joints). So, if anything, this is not about tumours. Because ESR may be not correct when there is microcytosis, you should have another marker of inflammatory response tested and this is CRP.

http://en.wikipedia.org/wiki/C-reactive_protein

Liver enzymes can be increased if you are on drugs of some kind (are you?), drink alocohol (needless to say you shouldn't) or have iron overload (which is rare in thal minors but can happen). The iron status can be assesed with the mentioned earlier tests: iron, TIBC and ferritin.
You rather do not have Wilson's disease, which also causes increased enzyme level.

http://en.wikipedia.org/wiki/Wilson%27s_Disease

Your doctor should definetely take a closer look at these liver enzymes.

B.

I am not on drugs, but i think i might have been at the time of the test.  (only cannabis, no alcohol).  Certain sites for ESR, including the one you showed me mention tumors.  Also, cancer related issues.

The liver enzymes was ever so slightly high, and since the Hep tests came back clear, he left it at that.  Im starting to dislike him, and think that just because i am fairly young male, he thinks i should be fine.

Just to re-iterate, i have completely given up smoking 3 months ago.

Well, I can completely understand that you are worried sick (I was in the very same position these 5 years ago), because you feel so terribly and it looks like there is no hope for recovery and no matter what you do, nothing seems to work and you don't know what you can do about it. So you're a doer, and that's good. Also you can see that your doctor does not give you the best care.
But there is a big BUT:
- Nothing indicates that there is something really wrong with your health because of increased ESR. Really really. If there was something wrong, ESR would much higher, like 20 during infection or like 100 (or even higher) during rheumatic disease or leukemia (I guess that's what you meant by cancer).
Also leukemia would cause other blood parameters to change CONSIDERABLY - white blood cells would be 15 000 - 20 000 and you have 5 800.
- Nothing can be determined further without the tests I mentioned earlier - it's just impossible. I can tell you that my ESR was 17 when I had broken ankle and a terrible inflammation there, but is this of any diagnostic value for you? No.
- This may be your completely normal ESR level anyway or it was higher because of little normal infection. It hapens everyday.
- No one's results are perfect, everybody has something out of range. And you have to live with this without dwelling on it. You may even check sometimes if it changed or got worse, but not too often.
- Worrying too much will only make things worse. When you worry, different hormonal changes affect your body (adrenalin, cortisol, they are not good), so you physically feel worse, not to mention psychically. Just forget about the problem until you get the new results back. That's what I do. If you suspect any disease, you can go www.emedicine.com. When you get educated about all this you will stop worrying.

I know that there are no stupid questions, but doctors really do not know about it, so if you ask your doctor a question like "Can this ESR mean cancer", he will only tell you "No" and will not order for you any other tests, thinking that you are exaggerating.
Before you go to the doctor I would suggest you to make a list of problems you have and tests you want, and each of these requests has to be supported in a way the doctor wants to hear, not what you think. So, what I'm saying is that you have to think like your doctor. This means that you have to learn a lot of things about your disease, but you will have to live with it, so I think it's a good idea. You will not win with the system if do not fit within it somehow, and this is most unfortunate. And the doctors will not explain everything to you, although it's their duty, but they think it's pointless and even dangerous (because you might try something on your own without taking into consideration side effects).

The list might look something like this:
* I have beta thal minor, could we test for:
- FBC
- free iron, TIBC and ferritin
- uric acid (because when red blood cells break, they release uric acid)
which are the basic tests for thalassemia, and I need them just for future reference.

(BTW. it's strange these were not done already, did you see hematologist, and also was fetal hemoglobin tested?)

* I have joint pains, could we test for CRP to see if there is inflammation?
* My liver enzymes were increased last time, could we retest?

And that's it. I used to go to doctors, who only took my list and prescribed me all I wanted and ordered any test I wanted, not because it was well argued, but they liked the new, fast approach and they could get rid of me faster. So I learnt to take advantage of the system pretty, pretty well  .

Have a good tomorrow.

B.

 

I feel like crying.  Im getting to the point where i cant take this anymore.  I want to compare to my older results to see if that will tell me anything but i fear will just get me more worried.  Im always worrying about something.  I wont get another test done, because this one only just got done.  3 weeks ago?  He will see it as no reason to get rechecked, at least for the time being which will leave me worrying in the mean time.

I find it so hard to take in what you say about asking for perticular tests.  I read it, but it just pops out of my head straight away.  I want to ask to be referred to hemotologist to properly talk about my health.  I got diagnosed with thal trait at birth.  Dont know if alpha or beta, but i assume beta.  Doc wrote i had Beta Thalassemia to an oral surgeon which was a little dumb, because he didnt write minor, or trait.  That makes me wonder if its even Beta or not.

Thanks for your reassurance.  Ill try and force myself to think that its because of other things but that doesnt work very well with me.  I worry with the presence of any possibility.  Which is all the time.  Going to cry myself to sleep now.

Thanks for your help my friend.  You are a good person.

Hi ak82,

Your ESR is well within the reference range and I agree with Bigg. It isn't anything to be concerned about at all. The reference range for ESR is 0-15 mm/hr in men and 0 - 20 mm/hr in women. 7 is not high at all. When they refer to a high ESR being cause for concern, the level is over 100. ESR is almost a meaningless test, that only has any meaning when the results are far out of range. It isn't anything to worry about.

You will not see immediate results from any supplement. It takes time for your body to correct deficiencies if they exist. And with your Hb as high as it is, you may not see any difference from folic acid, but it does have great value to the body. B-complex, vitamin D and magnesium may also be of some value. The sun is the best source of vitamin D and if you are deficient, you may notice you feel better on days when you get a lot of sun. Vitamin D also needs sufficient magnesium to work. Strange food cravings can mean a deficiency of some nutrient, and lemon craving can indicate a deficiency of iron or magnesium and can also mean a high level of toxins in the body. Some tests to be considered are iron studies, magnesium, vitamin B-12 and vitamin D tests.

Your hemoglobin and hematocrit are both on the low end of normal and this would not explain your tiredness. The joint pain is not a characteristic of thal trait. There could be a relation between the excess lemon consumption and the joint pain, so finding why you crave lemon might be the place to start. A magnesium supplement is cheap and would be easy to test to see if there is any relation to the lemon craving. (By the way, before I had my thyroid treated, I couldn't use any lemon as even the smallest amounts caused joint pain in my knees and knuckles).

With thal major, patients should start antibiotic therapy before having dental surgery because of the risk of bacterial contamination of the blood, which can lead to sepsis, which can be fatal. The doctor most likely advised the dentist without understanding the difference between major and minor, as far as the risk from surgery is concerned.

Hi Andy,

Its great to get a response from you.  I admire how pro active you are in these forums and its amazig to see how much you are willing to help people.  Thanks.

Again, just when i thought id cracked my tiredness, i appear to have been stifled.  I had a feeling you might say that my blood work may not indicate reasons for tiredness.  Does my low MCV and MCH not have anything to do with with it?  To me, they look well below the normal range, and i would have thought that that indicates that i am getting less oxygen to my body as someone with more regular levels.

As i say, the tiredness is also something that i have had for very many years.  I am also a fairly big person, so maybe the oxygen starvation is afecting me more?

I wonder whether i should cut out the lemon, but i dont know if that would be safe.

So a suggestion maybe to take magnesium?  Vit D i heard you say can be toxic in excess, so i guess ishould stay away from that.

Iron studies you say maybe something to look at.  But maybe my Hb and Hct levels suggest my iron is ok.

Im at odds again   Sometimes i feel like i need to just live with this, and excert myself until something major happens, then docs will have to take notice.  As i said, all i keep thinking these days, is that its something else, but have no idea what this something else could be, so get jumpy at the smallest sign of anything abnormal.  I usually think that its some sort of terminal illness.  I wonder if these thoughts are typpical of thals.  I read that dehydration can lead to false positive Hb and Hct readings.  Maybe i was dehydrated.  Unlikely though.  I tend to drink a lot of water most of the time.  It was during a very hot week though.

Do MCV and MCH on their own not cause tiredness?  Doesnt it mean i have small cells with small amounts of Hb in them, anda big body which is being insufficiently supplied?

I also read on a fair few sites that 14 is the low level for male HB.  I see a lot of people claiming they are healthy energetic at levels of 16.

Im at odds again   Sometimes i feel like i need to just live with this, and excert myself until something major happens, then docs will have to take notice.  As i said, all i keep thinking these days, is that its something else, but have no idea what this something else could be, so get jumpy at the smallest sign of anything abnormal.  I usually think that its some sort of terminal illness.  I wonder if these thoughts are typpical of thals.  I read that dehydration can lead to false positive Hb and Hct readings.  Maybe i was dehydrated.  Unlikely though.  I tend to drink a lot of water most of the time.  It was during a very hot week though.

to ak82

I have had this kind of thinking in the past, it was due to the fustration I was facing.But then I started,to think about the consequences of my actions, I came up with the answer that It was self distructive not to take good care of myself.
Even when the doctors  had let me down I needed to take the best care of my self that is because I love myself too much not to care.Our body is our responsiblity, we need to keep trying,  untill to the bitter end.
Good luck and do not lose hope because that is all we have to hold on to.
Kathy

ak82,

Have you ever had an echo cardiogram of your heart? It shows how well the blood is flowing through your heart and is an easy measure of heart function. I ask because I was wondering if the high amount of red blood cells along with the unmatched alpha globin in your blood, might be enough to cause an increase in blood viscosity and cause a reduced blood flow. Your Hb is fairly close to normal but that doesn't tell us how well your circulatory system is working. If it is sluggish, then it could explain the tiredness because your system would not be delivering oxygen efficiently throughout your body. If there is any suspicion of increased viscosity, vitamins E and C, along with folic acid may be of some help.

Also, the toxic dose for vitamin D is extremely high and it is not a reason to avoid the vitamin, which is the "hot" vitamin of the hour, and researchers are finding that many people are deficient and also that the recommended doses are much too low. A daily dose of 2000-3000 units is being recommended for many people who test low for D. From my own experience, I highly recommend D for anyone who suffers from any depression, as lack of exposure to sunlight is a main cause of depression.

I have never had an echo diagram of the heart and am unfmailiar with what this is and how i would get one.

Also, i have been thinking back on my life and realising that this is something that has been with me pretty much as far back as i can remember.  It has to be related to the thal.  I refuse to believe that some of my readings can be so far out of normal range and yet i wouldnt feel any adverse effects.  Fair enough my Hb is nearly in range but it is right at the bottom level.  My doctor even seemed almost concerned, but it was ME that said, oh dont worry that just ties in with the thalassemia trait.  I had other problems to worry about at the time, so this was not priority.

The supplements still dont seem to be working.  Ill try pick up some wheatgrass and Vit D supplements and see how that goes.  Otherwise, im jst going to have to live with it.  Im seeing a different doctor on Wednesday, and i will see if he has any suggestions.

Thanks again people for your time and efforts.  It is much appreciated.