Who wants to play a round of Dr. Hive: Blood Test Results?

[jenn-]

I've been on the hunt for a new doctor that I like this year since my old one retired almost 2 year ago.  I had a recommendation for a doctor back in March that I saw, but I didn't like the guy.  He did do some basic blood work though and referred me to the sleep doctor I needed (long time exhausted insomniac).  The sleep doctor did blood work both in the beginning of June and the end of August, but then referred me back to my primary to get my anemia looked at/treated.  I don't like the guy I saw one time, so I found someone else to try.  That appointment is still about 2 weeks away.  To speed up any diagnosing that might be needed, I swung by and picked up the lab results from the 3 different blood draws this year.  That was probably a mistake cause now I can see things that freak me out.

 

When a lab reports something a "normal," but you are only in the normal range by .05 when the range is small (RBC norm is 3.8-5.6), truly normal and nothing to worry about?  How about when you fall out the bottom of normal in the same count 5 months later by .3?  Is that just normal fluctuation? 

 

How about when you start with barely in by 4 points (platelets have a large range of normal 140-415) and then drop 15 points out 3 months later and although the number improved in August, it is still 4 points south of the "norm"?  Does this change if you have had thrombocytopenia with all 3 pregnancies?

 

I think one of the big concerns for me is that I was looking up results and one of the things that can supposedly cause a high platelet count is iron-deficient anemia which either means my anemia isn't of the iron-deficient type, or that my platelets would be really scary numbers if I wasn't anemic.  The anemia itself falls into the barely anemic range, but that is taking a supplement every day. 

 

My number one goal of the new doctor is to find out what type of anemia I have.  Having been anemic since high school, I think it is time to figure out why.  The red blood count can be explained away by the anemia, as anemia can cause a low RBC. 

 

There were several other tests that had me within a few points of falling out the bottom and one that was a point from busting out the top.  These were tests that had a decent range of normal.  Is there usually a truly normal within the normal or is anything that stays within their magic numbers really okay?

[Tap]

Just remember that those normal ranges are just averages based on what is typically seen.  Even within different labs, the values can vary on what is in the normal range and what is not.  Your doctor will really need to look at your all over health, age, genetic background, race, gender and a slew of other things to determine if being in the normal range is what it healthiest for you or not.  

 

You can be outside of the normal range and be perfectly healthy, asymptomatic for many ranges.  Other ranges, the doctor may not be happy with a normal range value.  Really, only a doctor can make those determinations with you.  And to complicate matters, different doctors will have different expertise and will treat/not treat different ranges with different approaches, based on their own expectations and experiences. 

 

 

 

For instance, I have been going to my PCP for some muscle/leg/blood pressure problems.  She did some blood work, determined I was low on Vit D and Vit B12 and had me supplementing to raise those values.  I was referred to a Neurologist who determined that my ferritin levels were in the low-normal range but due to my leg discomfort, I needed to treat with supplements. Within 2 weeks of supplementing my iron, my legs feel much better so the 'low-normal' iron results really are at least part of my problem. I started doing some research and I find that this is a very common correlation between Restless leg and lower ferritin scores. 

 

But the neurologist really wasn't concerned at all about some of my other borderline scores, that my PCP said 'we will retest and keep an eye on these values'.  Different specialties, different focus.  

 

 

[ZeeMommy]

Get more past results, as many as you can.  3 sets of test results don't really give you a good overview. You might always be running on the low side of normal on average. 

 

This is an excellent website for understanding just about every possible lab test:  www.labtestsonline.org

 

Types of anemia are diagnosed by more than just your RBC count - there's other tests/results involved.  I can't remember them off the top of my head, but I will try to nose around in my lab books and info to give you more details.  (I'm a medical lab technician.) 

 

Above all, don't freak out!  If you were to take the same tube of blood and run the same tests on it 10 times in a row, all of the answers would fluctuate a little.  Not unusual to have anyone's results fluctuate from one blood draw to another.  Big changes, not good.  Small changes, okay.

[jenn-]

Get more past results, as many as you can. 3 sets of test results don't really give you a good overview. You might always be running on the low side of normal on average.

 

This is an excellent website for understanding just about every possible lab test: www.labtestsonline.org

 

Types of anemia are diagnosed by more than just your RBC count - there's other tests/results involved. I can't remember them off the top of my head, but I will try to nose around in my lab books and info to give you more details. (I'm a medical lab technician.)

 

Above all, don't freak out! If you were to take the same tube of blood and run the same tests on it 10 times in a row, all of the answers would fluctuate a little. Not unusual to have anyone's results fluctuate from one blood draw to another. Big changes, not good. Small changes, okay.

How far back before the results really don't help? My last big draw when not pregnant was over 9 yrs ago. Other than that there has been 1 finger prick for cholesterol and blood sugars through dh's work. I'm a fairly healthy person and avoid doctors like the plague. The blood work from my pregnancies would do them no good cause pregnancy messes me up something fierce.

[fourcatmom]

Get more past results, as many as you can.  3 sets of test results don't really give you a good overview. You might always be running on the low side of normal on average. 

 

This is an excellent website for understanding just about every possible lab test:  www.labtestsonline.org

 

Types of anemia are diagnosed by more than just your RBC count - there's other tests/results involved.  I can't remember them off the top of my head, but I will try to nose around in my lab books and info to give you more details.  (I'm a medical lab technician.) 

 

Above all, don't freak out!  If you were to take the same tube of blood and run the same tests on it 10 times in a row, all of the answers would fluctuate a little.  Not unusual to have anyone's results fluctuate from one blood draw to another.  Big changes, not good.  Small changes, okay.

 

n/m

[jenn-]

Just remember that those normal ranges are just averages based on what is typically seen.  Even within different labs, the values can vary on what is in the normal range and what is not.  Your doctor will really need to look at your all over health, age, genetic background, race, gender and a slew of other things to determine if being in the normal range is what it healthiest for you or not.  

 

You can be outside of the normal range and be perfectly healthy, asymptomatic for many ranges.  Other ranges, the doctor may not be happy with a normal range value.  Really, only a doctor can make those determinations with you.  And to complicate matters, different doctors will have different expertise and will treat/not treat different ranges with different approaches, based on their own expectations and experiences. 

 

 

 

For instance, I have been going to my PCP for some muscle/leg/blood pressure problems.  She did some blood work, determined I was low on Vit D and Vit B12 and had me supplementing to raise those values.  I was referred to a Neurologist who determined that my ferritin levels were in the low-normal range but due to my leg discomfort, I needed to treat with supplements. Within 2 weeks of supplementing my iron, my legs feel much better so the 'low-normal' iron results really are at least part of my problem. I started doing some research and I find that this is a very common correlation between Restless leg and lower ferritin scores. 

 

But the neurologist really wasn't concerned at all about some of my other borderline scores, that my PCP said 'we will retest and keep an eye on these values'.  Different specialties, different focus.  

 

See, my leg discomfort was treated by the sleep doctor.  He also agrees about a low ferritin score and RLS.  The difference is that with 2 months of doubling my normal iron supplement, the ferritin level dropped a point.  I think he would have been happy if it had gone up at least a point or two.  My overall iron counts also dropped with the added iron.  This is what has me scratching my head over this problem and why I want to get to the bottom of it first.  I can swallow as much iron as they want, but if my real problem is a low Vit D or B12, then nothing is going to be fixed.

 

 

[Tap]

See, my leg discomfort was treated by the sleep doctor.  He also agrees about a low ferritin score and RLS.  The difference is that with 2 months of doubling my normal iron supplement, the ferritin level dropped a point.  I think he would have been happy if it had gone up at least a point or two.  My overall iron counts also dropped with the added iron.  This is what has me scratching my head over this problem and why I want to get to the bottom of it first.  I can swallow as much iron as they want, but if my real problem is a low Vit D or B12, then nothing is going to be fixed.

 

 

Which iron are you taking and which strength? Are you taking it at the same time as Vit C or something acidic like orange juice?

[jenn-]

That's interesting. I have been stewing over a lab test for about a week with results from a blood test that were flagged by the lab  and no info form the doctor. And the test is not listed on that site. 

 

Do you know anything about hypersensitivity pneumonitis ll?

 

ETA: I know that it means lung inflammation and the one that showed "detected" was the one that was specific for Farmer's Lung but I don't understand if a "detected" from the lab = a positive for a diagnosis? 

 

Have you called and asked the doctor about it?  Do you live/work on a farm?

[jenn-]

Which iron are you taking and which strength? Are you taking it at the same time as Vit C or something acidic like orange juice?

 

I started a thread about coffee and iron yesterday and it was determined I should probably try a different iron.  I just use whatever it is I get from Walmart and it is the 325mg/65mg stuff.  Can't drink OJ care of first pregnancy, but I do try and have a high Vit C food for breakfast most mornings, and it is taken with my multivitamin that I assume has some in it.  I have also added a Vit C with my nighttime pill since it is usually taken on an empty stomach.  I'm not going to change anything else supplement wise until I see the new doctor.  I am trying really hard to be mindful of my diet as I got lazy there for a couple of weeks (as a vegetarian lazy means not making sure you get all the good stuff from plants).

[Tap]

I started a thread about coffee and iron yesterday and it was determined I should probably try a different iron.  I just use whatever it is I get from Walmart and it is the 325mg/65mg stuff.  Can't drink OJ care of first pregnancy, but I do try and have a high Vit C food for breakfast most mornings, and it is taken with my multivitamin that I assume has some in it.  I have also added a Vit C with my nighttime pill since it is usually taken on an empty stomach.  I'm not going to change anything else supplement wise until I see the new doctor.  I am trying really hard to be mindful of my diet as I got lazy there for a couple of weeks (as a vegetarian lazy means not making sure you get all the good stuff from plants).

You likely already know this, but just in case I will throw it out there. 

 

Iron should be taken about an hour before any food and with about 100mg of vit C or higher.  (unless it upsets your stomach on an empty stomach).  Either way, it should not be taken with dairy products.

 

I have heard that a multivite is not the best choice for adding C to an iron dose because if it has calcium, zinc or something else that I don't remember, it can block some of the iron. How much blocking is going on, I don't know, and  I have no proof of that or data, it was just what a pharmacist told me, when I asked.

 

There are some meds that discourage iron absorption like PPIs (protonix, prilosec, etc) so make sure if you are taking anything like that over the counter, that your doctor knows. Also thyroid meds are affected by iron, so they shouldn't be taken together. 

[melmichigan]

You likely already know this, but just in case I will throw it out there. 

 

Iron should be taken about an hour before any food and with about 100mg of vit C or higher.  (unless it upsets your stomach on an empty stomach).  Either way, it should not be taken with dairy products.

 

I have heard that a multivite is not the best choice for adding C to an iron dose because if it has calcium, zinc or something else that I don't remember, it can block some of the iron. How much blocking is going on, I don't know, and  I have no proof of that or data, it was just what a pharmacist told me, when I asked.

 

There are some meds that discourage iron absorption like PPIs (protonix, prilosec, etc) so make sure if you are taking anything like that over the counter, that your doctor knows. Also thyroid meds are affected by iron, so they shouldn't be taken together. 

:iagree: Iron with high acid or vitamin C, at least an hour before or at least two hours after meals or caffeine, as a separate supplement and without other meds.  At least four hours either side of thyroid meds. If you are really struggling with anemia then you need to know your hemoglobin, your iron level, and your iron saturation level every 2-3 months to see what is going on so that a diagnosis can be made.  Ferrochel is the only thing that I can take anymore, but I do take 100mg a day of it because I've been trying to bring my iron saturation up from zero.  

[jenn-]

You likely already know this, but just in case I will throw it out there. 

 

Iron should be taken about an hour before any food and with about 100mg of vit C or higher.  (unless it upsets your stomach on an empty stomach).  Either way, it should not be taken with dairy products.

 

I have heard that a multivite is not the best choice for adding C to an iron dose because if it has calcium, zinc or something else that I don't remember, it can block some of the iron. How much blocking is going on, I don't know, and  I have no proof of that or data, it was just what a pharmacist told me, when I asked.

 

There are some meds that discourage iron absorption like PPIs (protonix, prilosec, etc) so make sure if you are taking anything like that over the counter, that your doctor knows. Also thyroid meds are affected by iron, so they shouldn't be taken together. 

 

 

:iagree: Iron with high acid or vitamin C, at least an hour before or at least two hours after meals or caffeine, as a separate supplement and without other meds.  At least four hours either side of thyroid meds. If you are really struggling with anemia then you need to know your hemoglobin, your iron level, and your iron saturation level every 2-3 months to see what is going on so that a diagnosis can be made.  Ferrochel is the only thing that I can take anymore, but I do take 100mg a day of it because I've been trying to bring my iron saturation up from zero.  

 

I am lactose intolerant so already dairy free.  No heartburn meds either.  It is not physically possible for me to be up for an hour before food hits the stomach or I will be vomiting.  I have started taking my morning iron as soon as I roll out of bed and I don't drink coffee for a couple of hours later.  I guess I could move my multivitamin closer to my coffee time, but I will probably forget it more often then not if I don't stay with my normal schedule.  No thyroid issues, but I am taking a med that typically treats Parkinson's patients.  The sleep doctor is the one that put me on it and he never mentioned avoiding the iron at the same time.

 

My most recent hemoglobin was 11.7.  The hematocrit was at 34.1.  The ferritin level was at 69 which is down one from June but up 14 from March.  The sleep dr says that RLS symptoms can be problematic if the ferritin level is below 75.  Since I am symptomatic, it needs to come up.  The test from March shows an iron saturation of 16.9% which is within normal, but both the hemoglobin and hematocrit were up in the normal range by a couple of decimal points at that time as well.

 

I hope this new doctor is more proactive about finding a cause or at least which type of anemia this is.  I'd be content with my numbers if I wasn't supplementing, but supplementing more and falling out of norm concerns me.

[melmichigan]

I am lactose intolerant so already dairy free.  No heartburn meds either.  It is not physically possible for me to be up for an hour before food hits the stomach or I will be vomiting.  I have started taking my morning iron as soon as I roll out of bed and I don't drink coffee for a couple of hours later.  I guess I could move my multivitamin closer to my coffee time, but I will probably forget it more often then not if I don't stay with my normal schedule.  No thyroid issues, but I am taking a med that typically treats Parkinson's patients.  The sleep doctor is the one that put me on it and he never mentioned avoiding the iron at the same time.

 

My most recent hemoglobin was 11.7.  The hematocrit was at 34.1.  The ferritin level was at 69 which is down one from June but up 14 from March.  The sleep dr says that RLS symptoms can be problematic if the ferritin level is below 75.  Since I am symptomatic, it needs to come up.  The test from March shows an iron saturation of 16.9% which is within normal, but both the hemoglobin and hematocrit were up in the normal range by a couple of decimal points at that time as well.

 

I hope this new doctor is more proactive about finding a cause or at least which type of anemia this is.  I'd be content with my numbers if I wasn't supplementing, but supplementing more and falling out of norm concerns me.

Are you currently pregnant or breastfeeding, or recently given birth? Do you still have monthly periods?  If none of those apply do you run for exercise?  All would already change your iron demands regardless of supplementation.  

 

If you are supplementing then it's favorable to spread your iron out, two or three times a day (unless you are taking Ferrochel) because only so much mineral iron can be absorbed by the small intestine at a time.  

 

There are additional tests that would be helpful in determining the type of anemia.  Is your iron saturation normal?

[ZeeMommy]

Ok - basic info about the types of anemia.  Anemia is a pretty general term, medically speaking.  There are two main categories of anemia:  less circulating red cells, or something wrong with the hemoglobin (stuff that carries oxygen in the red cells).  You can have some kinds of anemia that are caused because of decreased production of red cells or defective production of red cells.  In other words, you're making less or there's something wrong in the making of them.  You can also be anemic because something is causing red cell destruction; blood loss, something wrong with the structure of the cells, or something outside the cells that is destroying the cells. 

 

Now for some basic info on the lab tests that look at red cells.  Your complete blood count, or CBC, measures how many red cells (RBC count), how much hemoglobin (HGB), how much red cells in proportion to blood volume (hematocrit), and then there will be another bunch of initials that are called the red cell indices.  These are average blood cell size/how big is that red cell (MCV, mean corpuscular volume), how much hemoglobin is in each cell (MCH, mean corpuscular hemoglobin), and the concentration of hemoglobin in the red cell (MCHC, mean corpuscular hemoglobin concentration).  All of these red cell indices will be helpful in diagnosing the kind of anemia you might have.  In some kind of anemia, the cells are larger but have normal amounts of hemoglobin in them.  This would include anemia from lack of vitamin B12 and anemia lack of folate.  In other kinds of anemia, the cells are smaller and have less hemoglobin in them.  This would include iron deficiency anemia, and two other kinds.  Then there's the anemia where the cells are normal size and have normal amounts of hemoglobin in them.  Here you'll find blood loss, sickle cell anemia, not making enough red cells, fragile cells that break, or red cells being destroyed because of chronic infection, inflammation, malignancy.  The lab techs might also be taking a look at your cells under a microscope to see what they look like, depending on what the indices are like.

 

Doctors can also place orders for other tests that help diagnose the type of anemia.  This would be testing for vitamin B12, folate/folic acid, total iron binding capacity (TIBC), iron, and ferritin.  All of these have to do with the dietary things you need (vitamins) and how your body is using them.  The platelet count is not really anything in diagnosing anemia, and the numbers that you have haven't really fluctuated that much.  It's an actual count that the hematology analyzer does; in other words, in the amount of blood that got run through the machine, it counted X number of platelets.   

[jenn-]

Are you currently pregnant or breastfeeding, or recently given birth? Do you still have monthly periods?  If none of those apply do you run for exercise?  All would already change your iron demands regardless of supplementation.  

 

If you are supplementing then it's favorable to spread your iron out, two or three times a day (unless you are taking Ferrochel) because only so much mineral iron can be absorbed by the small intestine at a time.  

 

There are additional tests that would be helpful in determining the type of anemia.  Is your iron saturation normal?

 

Youngest is 8 and a doctor is getting sued if I end up pregnant.  I do have monthly periods that are on the heavy side IMO but not to the point that I am stuck at home.  Although I don't run, I do taekwondo 3-4 times a week and those are pretty physical practices.  I do take my iron once in the morning and once at night.  My iron saturation was 16.9% (normal range is 10-58% according to lab) so technically normal but on the lower end of the range.

 

[jenn-]

Ok - basic info about the types of anemia.  Anemia is a pretty general term, medically speaking.  There are two main categories of anemia:  less circulating red cells, or something wrong with the hemoglobin (stuff that carries oxygen in the red cells).  You can have some kinds of anemia that are caused because of decreased production of red cells or defective production of red cells.  In other words, you're making less or there's something wrong in the making of them.  You can also be anemic because something is causing red cell destruction; blood loss, something wrong with the structure of the cells, or something outside the cells that is destroying the cells. 

 

Now for some basic info on the lab tests that look at red cells.  Your complete blood count, or CBC, measures how many red cells (RBC count), how much hemoglobin (HGB), how much red cells in proportion to blood volume (hematocrit), and then there will be another bunch of initials that are called the red cell indices.  These are average blood cell size/how big is that red cell (MCV, mean corpuscular volume), how much hemoglobin is in each cell (MCH, mean corpuscular hemoglobin), and the concentration of hemoglobin in the red cell (MCHC, mean corpuscular hemoglobin concentration).  All of these red cell indices will be helpful in diagnosing the kind of anemia you might have.  In some kind of anemia, the cells are larger but have normal amounts of hemoglobin in them.  This would include anemia from lack of vitamin B12 and anemia lack of folate.  In other kinds of anemia, the cells are smaller and have less hemoglobin in them.  This would include iron deficiency anemia, and two other kinds.  Then there's the anemia where the cells are normal size and have normal amounts of hemoglobin in them.  Here you'll find blood loss, sickle cell anemia, not making enough red cells, fragile cells that break, or red cells being destroyed because of chronic infection, inflammation, malignancy.  The lab techs might also be taking a look at your cells under a microscope to see what they look like, depending on what the indices are like.

 

Doctors can also place orders for other tests that help diagnose the type of anemia.  This would be testing for vitamin B12, folate/folic acid, total iron binding capacity (TIBC), iron, and ferritin.  All of these have to do with the dietary things you need (vitamins) and how your body is using them.  The platelet count is not really anything in diagnosing anemia, and the numbers that you have haven't really fluctuated that much.  It's an actual count that the hematology analyzer does; in other words, in the amount of blood that got run through the machine, it counted X number of platelets.   

 

This is very helpful and I have some of these numbers but I have to run out the door to be beaten up by some younger kids.  Quick question though, would the supplementing I've been doing for the last 14+ years throw off the numbers?  I don't have a clue what my numbers would be if I wasn't taking something at all.

 

[ZeeMommy]

Now for a little on how your body absorbs/uses iron.  There are two types that you can ingest, heme iron and non-heme iron.  Heme iron is the kind you would find in red meat, also in seafood and poultry.  It is the most easily absorbed by the body.  Non-heme is the kind that you find in fortified foods, vitamins, and plants.  It is not as easily absorbed as heme iron; vitamin C does increase the absorption of non-heme iron.  If you are a woman, pregnant, or a vegetarian, your need for iron will be greater.  That vitamin C, I'm guessing, could come in the form of a nice refreshing glass of orange juice you drink down with your iron supplement.  

 

Your hemoglobin and hematocrit, although low, aren't anything I'd freak out about if I were working in the lab and reviewing your results.  I had to look up the normal ranges for ferritin, but they are pretty broad, from 11 - 307 mcg/L for women.  However, go with what the sleep doctor says on where that ferritin number should be.  You've gone up and held steady, so that is probably good.  Your hemoglobin and hematocrit are up, so that's good too.  Iron saturation is one of those tests that I just haven't dealt with in a good 10 years as a tech, so not sure what to think there.

 

Not all multivitamins are effective, from what I've learned from the herbalist/nutritionist that we occasionally see.  Personally I usually go with what our herbalist/nutritionist recommends.  I do know that NOW brand of supplements is reliable, not too pricey, and available on Swanson Vitamins website.

 

Checking the potential interactions and side effects of drugs and vitamins is always a wise thing to do.  Pharmacy might be more helpful in figuring that out than the doctor.

 

Sounds like the sleep doctor has a pretty good handle on your lab tests, results, and where you should be.  If you don't like the newest doctor, then see if the sleep doctor can help you out some more since it's related to your RLS.  A good herbalist/nutritionist/naturopathic doctor would be helpful too, since they tend to look at the whole person and not just separate problems/diseases.  They are hard to find and not covered by insurance though.  They also usually can't order lab tests; that's something that only medical doctors can do.  

 

Don't be afraid to switch doctors until you are satisfied with one.  Ask around, and not just "who do you see" but "why that doctor" and "why do you like them" and "what is their personality"?  Working in a clinic, I've been able to see what the different doctors are like, their personalities, and the general personality of their patients.  The patients who like their doctors and feel like they get good treatment from them generally like the way their doctors act too.  I picked my last regular doctor because I could see that he was thorough, took his time with the patients, was friendly but effective as well.

 

DISCLAIMER:  I am a medical lab technician, not a doctor.  I've worked in my field for about 14 years, but most of that time has been spent poking people with needles and running specimens through lab instruments.  Most of what I've written has come from my memory/learning/schooling/experience, my pathophysiology book and information from technical websites when I can't remember all the gory details! 

[ZeeMommy]

My guess is that if your supplementation has been regular and consistent, then it shouldn't throw off the numbers. 

 

Heavy periods might affect your hemoglobin.

 

You said you were anemic since high school - how long ago was that and do you remember how it was diagnosed?  Were you supplementing iron then?

 

While you go get beaten up by kids, I have to go wipe a butt and open some letters my other munchkins wrote!  :)  Will check back later...

[Tiramisu]

Have you had an endoscopy and colonoscopy? That is a common course of action when there is unexplainable long term anemia, to check for any bleeding in the GI tract?

 

First, though, I would also suggest a thorough autoimmune workup, especially considering your thrombocytopenia in pregnancy. The low RBC and low platelets can be caused by things like lupus. I have a family friend with thrombocytopenia and another who had acute anemia; both are autoimmune in nature. 

[Harriet Vane]

I am lactose intolerant so already dairy free.  No heartburn meds either.  It is not physically possible for me to be up for an hour before food hits the stomach or I will be vomiting.  I have started taking my morning iron as soon as I roll out of bed and I don't drink coffee for a couple of hours later.  I guess I could move my multivitamin closer to my coffee time, but I will probably forget it more often then not if I don't stay with my normal schedule.  No thyroid issues, but I am taking a med that typically treats Parkinson's patients.  The sleep doctor is the one that put me on it and he never mentioned avoiding the iron at the same time.

 

My most recent hemoglobin was 11.7.  The hematocrit was at 34.1.  The ferritin level was at 69 which is down one from June but up 14 from March.  The sleep dr says that RLS symptoms can be problematic if the ferritin level is below 75.  Since I am symptomatic, it needs to come up.  The test from March shows an iron saturation of 16.9% which is within normal, but both the hemoglobin and hematocrit were up in the normal range by a couple of decimal points at that time as well.

 

I hope this new doctor is more proactive about finding a cause or at least which type of anemia this is.  I'd be content with my numbers if I wasn't supplementing, but supplementing more and falling out of norm concerns me.

 

Quite frankly, I feel HORRIBLE when my numbers are as low as yours are. Isn't "normal" hemoglobin supposed to be 12 or higher?

 

I try to keep my ferritin above 100 and hemoglobin above 12. If these numbers reflect what you are able to maintain with your supplements, then I think you should take more supplements for 6-8 months to try to boost those numbers, and then ease back to a maintenance dose.

 

[jenn-]

First off, let me thank each and every one of you that has replied to this thread.  You are all being very helpful and giving me great talking points for the appointment.  Granted the doctor will probably roll their eyes and hope I never come back.

 

My guess is that if your supplementation has been regular and consistent, then it shouldn't throw off the numbers. 

 

Heavy periods might affect your hemoglobin.

 

You said you were anemic since high school - how long ago was that and do you remember how it was diagnosed?  Were you supplementing iron then?

 

While you go get beaten up by kids, I have to go wipe a butt and open some letters my other munchkins wrote!  :)  Will check back later...

 

I guess my thought with the supplementation is, what would my numbers look like if I didn't take those pills?  Would I maintain where I am or keel over?

 

I was first told I was anemic by The American Red Cross worker that wouldn't allow me to donate.  I think my hematocrit was 34 back then without the supplement.  She said I had enough for myself, but not enough to share.  This was confirmed several times as I tried to donate blood.  I was a mean friend who knew I probably wouldn't be able to donate, but I dragged all my friends in to donate in my place. 

 

It wasn't until I was pregnant with DD that I dropped to a level that I had to supplement and I've had to ever since.  I didn't not know about the pregnancy induced thrombocytopenia until the anesthesiologist came in while I was in labor and told me I couldn't have my epidural.  Then they said I probably had cancer.  I didn't know the name of the disease until I was pregnant with the twins.  I was "this close" to having to have a transfusion before I could deliver them.  He induced me with my youngest once my numbers hit a certain mark.

 

I became a dairy free vegetarian (still eating eggs) earlier this year after living a low carb meat filled lifestyle for the last 7 years.  I was still anemic during those times.  OJ makes me want to vomit care of first pregnancy.  Is it safe to take a Vit C pill more than once a day?  Mine is like a 1000mg pill and says take once daily.

 

Now back to my current numbers.  My most recent test was 5 days ago.  At the time, this is how I was followed by what this lab considers normal.

RBC   3.64    (3.8-5.0)

Hemo   11.7   (12.0-16.0)

Hema   34.1   (37.0-47.0) (this has been a steady decline since March)

MCV   93.7   (82.0-100.0)

MCH   32.1   (27.0-33.0)

MCHC  34.3  (31.0-36.0)

RDW   12.9  (11.5-14.5) (no idea what this one is)

Platelets  136  (140-440)  (this one concerns me because of that cancer word they threw out at me as they handed me my newborn)

Iron binding capacity total   326  (205-512) This result is from March since I don't see it on the other test forms.

 

Have you had an endoscopy and colonoscopy? That is a common course of action when there is unexplainable long term anemia, to check for any bleeding in the GI tract?

 

First, though, I would also suggest a thorough autoimmune workup, especially considering your thrombocytopenia in pregnancy. The low RBC and low platelets can be caused by things like lupus. I have a family friend with thrombocytopenia and another who had acute anemia; both are autoimmune in nature. 

 

Nobody has ever cared enough to find the cause of my anemia so no endoscopy or colonoscopy.  Other then the first time when I was pregnant with DD and exhausted, my iron counts don't really bother me beyond the RLS (or I've felt like this for so long that I don't know any better).  We were anticipating it with the following pregnancies and I upped the iron immediately.  I've seen several references to various autoimmune disorders mentioned here and in my coffee thread that I will definitely bring it up.

 

Quite frankly, I feel HORRIBLE when my numbers are as low as yours are. Isn't "normal" hemoglobin supposed to be 12 or higher?

 

I try to keep my ferritin above 100 and hemoglobin above 12. If these numbers reflect what you are able to maintain with your supplements, then I think you should take more supplements for 6-8 months to try to boost those numbers, and then ease back to a maintenance dose.
 

 

Yeah, hemoglobin is supposed to be above 12.  Right now I am just trying to figure out what kind of supplementation I really need.  If I am missing B12, swallowing more iron isn't going to fix it.

[kiwik]

If you had cancer when your child was born something would have happened by now. Relax and wait until you talk to the doctor.

[jenn-]

If you had cancer when your child was born something would have happened by now. Relax and wait until you talk to the doctor.

 

Yeah, they stopped that talk when the numbers went back up on their own.  The pregnancy induced thrombocytopenia explained those numbers.  They just didn't use them.  I just know that low platelets are a sign of cancer because of their comments.

[Catherine]

Your CBC is not consistent with iron deficiency *alone*. Since anemia is so incredibly common, it's completely possibly to have anemia that is multifactorial. IMO, you need a good primary care person, who will look into this carefully. Often, abnormal hemoglobin is the cause of chronic, unexplained, mild anemia that is NOT due to iron deficiency. That can be detected with a blood test, a hemoglobin electrophoresis, and the causes are things like thalassemia trait, or similar inhertied disorders.

 

What is important, in turn, about that is that not all anemia is caused by iron deficiency. If it has been established that you are NOT iron deficient, you should not take supplements. Iron can accumulate in tissues, especially the liver and heart, when it is taken in excess of body needs, and this accumulation can be harmful. Just in case you needed something else to worry about...

[jenn-]

Your CBC is not consistent with iron deficiency *alone*. Since anemia is so incredibly common, it's completely possibly to have anemia that is multifactorial. IMO, you need a good primary care person, who will look into this carefully. Often, abnormal hemoglobin is the cause of chronic, unexplained, mild anemia that is NOT due to iron deficiency. That can be detected with a blood test, a hemoglobin electrophoresis, and the causes are things like thalassemia trait, or similar inhertied disorders.

 

What is important, in turn, about that is that not all anemia is caused by iron deficiency. If it has been established that you are NOT iron deficient, you should not take supplements. Iron can accumulate in tissues, especially the liver and heart, when it is taken in excess of body needs, and this accumulation can be harmful. Just in case you needed something else to worry about...

 

All the responses have confirmed what I was thinking.  Time to get to the bottom of all of this and keep looking for a doctor until one takes me seriously.  Hopefully the next one will. 

 

My liver seems fine according to my metabolic panel that the doctor ordered in March.  No clue if any of these number have to with my heart though.  My sodium, chloride, and potassium were up on the high end of normal, but everything else looked pretty much in the middle of the normal ranges.

[jenn-]

Would my low blood pressure play a role in all of this? Normal numbers are 95/60 with 90/55 not being uncommon. I can definitely feel it when it drops below the 90/55 range. I just feel "off".

[Kerileanne99]

See, my leg discomfort was treated by the sleep doctor. He also agrees about a low ferritin score and RLS. The difference is that with 2 months of doubling my normal iron supplement, the ferritin level dropped a point. I think he would have been happy if it had gone up at least a point or two. My overall iron counts also dropped with the added iron. This is what has me scratching my head over this problem and why I want to get to the bottom of it first. I can swallow as much iron as they want, but if my real problem is a low Vit D or B12, then nothing is going to be fixed.

 

 

Jenn,

I really hope you get some satisfactory results from your new doctor. I am also anemic more often than not (and vegetarian, lactose intolerant) so I understand that food-wise there is only so much you can do. A couple of things: even if you are taking a B12 supplement, it is possible that your body will not be able to utilize it. My RLS issues were almost cleared up by the implementation of monthly B12 shots. It also keeps my anemia in check.

I also take an iron supplement, in liquid form which my doctor swears by, first thing in the morning with a vit C supplemented smoothy. I found it was the only way as anything too acidic will make me vomit:(

And of course, simple things to release the iron in foods. For example, when we cook black beans I use just a bit of lemon juice. We cook in a cast-iron skillet often. Little things like that are obviously not going to clear up severe anemia on their own, lol, but every little bit helps. We are a family of vegetarians so I am also looking out for them.

I hope you get some relief. I think chronic fatigue is such a silent, miserable state that affects your whole life, in ways nobody can see or understand. Best of luck:)

[jenn-]

Jenn,

I really hope you get some satisfactory results from your new doctor. I am also anemic more often than not (and vegetarian, lactose intolerant) so I understand that food-wise there is only so much you can do. A couple of things: even if you are taking a B12 supplement, it is possible that your body will not be able to utilize it. My RLS issues were almost cleared up by the implementation of monthly B12 shots. It also keeps my anemia in check.

I also take an iron supplement, in liquid form which my doctor swears by, first thing in the morning with a vit C supplemented smoothy. I found it was the only way as anything too acidic will make me vomit:(

And of course, simple things to release the iron in foods. For example, when we cook black beans I use just a bit of lemon juice. We cook in a cast-iron skillet often. Little things like that are obviously not going to clear up severe anemia on their own, lol, but every little bit helps. We are a family of vegetarians so I am also looking out for them.

I hope you get some relief. I think chronic fatigue is such a silent, miserable state that affects your whole life, in ways nobody can see or understand. Best of luck:)

 

Thanks.  I've never taken a B12 supplement.  Never knew I might need it until reading it here.  Great tip about adding lemon juice to beans.  I was thinking of mixing up a bean salad for some easy meals this week and I will definitely toss some in.  We cook just about everything in a cast iron skillet and we have since one of my twins was found to be anemic as a wee little one through WIC. 

 

[ZeeMommy]

Thrombocytopenia = big medical word which means your platelet count fell below 100.  May I please go and smack the idiot who said the word cancer to you, because not all thrombocytopenia is caused by cancer!  Like anemia, there are several causes.  According to the Mayo website, pregnancy can cause low platelets.  www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/causes/con-20027170  

 

 

[ZeeMommy]

RDW stands for red cell distribution width.  It's a calculation from the other red cell values that shows if the cells are all the same size or if there's different sizes. 

 

There is a kit you can get from your doctor and/or the lab you get your blood drawn from.  iFOBT is the name, or ask for fecal occult blood screening kit.  It's simple, and it will check to see if there is any bleeding in the GI tract before you go the endoscopy/colonoscopy route. 

 

It's time to let the doctor bang his/her head against this dilemma; that's what we pay them to do!  ;)  And you should probably aim for more of an answer from them than "take more vitamin B12" or "take more iron", because you've tried stuff like that already and you are still having problems. 

[jenn-]

Thrombocytopenia = big medical word which means your platelet count fell below 100.  May I please go and smack the idiot who said the word cancer to you, because not all thrombocytopenia is caused by cancer!  Like anemia, there are several causes.  According to the Mayo website, pregnancy can cause low platelets.  www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/causes/con-20027170  

 

If it makes you feel any better, it was a military teaching school and they probably just said the first thing that came out of their mouth.  I was more surprised that no one caught it before the anesthesiologist was called in at 1030pm.  The guy putting in my IV had a fun time as well when he forgot to release the band on my arm and I shot blood across the room.  That was probably the wrong time for some of the other students sitting around watching him to realize they had an issue with blood as several ran from the room.

 

I'm at peace with waiting for the doctor at this point.  Besides now I get to fixate on my DH's blood work he had done last night.  His MCH was high by .5 and MPV was 1.7 low, so he will be getting it done again eventually.  He was at an urgent care center for extreme vertigo and I made sure to get a copy of his results since it's been a while for him. 

[Tiramisu]

jenn, I think it couldn't hurt at all to take a B12 supplement since you said you haven't taken one before. B12 comes from animal products and if you are a dairy-free vegetarian, you may need it even if you do eat eggs. It might not explain any anemia in the past, but it might help now considering your new eating style. B12 is helpful in many ways, and not just for anemia.