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Suggest Treatment For Elevated Red Blood Cell Distribution Width
Question: Hi. I have had significant changes in my blood work in the past few months/years. Everything in my blood work has pretty much fallen in normal ranges except RDW 14.3, 16.6, 17.1, 18.7 and PLATELET 260, 373, 494, 487. My FERRATIN was 4 and I know my vitamin d levels have been low in the past. I see an increase in these levels that I have shared. Should I be concerned? What do you suggest? I am 29 do not smoke but have had numorous symptoms in the past few years.
Brief Answer:
Hi I would advice joint examination and repeat blood test,peripheral smear
Detailed Answer:
Hi, I did review your concern mam.
Your RDW is increasing and with a normal hemoglobin count it should ideally mean very early iron deficiency anemia or anemia of chronic disease.(Hemoglobin should be low, but not necessarily in very early phase of the problem). In a young female that is generally either due to excessive menstrual bleeding or diet poor in iron rich food. Early iron deficiency anemia can lead to normal hemoglobin but high RDW and low MCV. If still the RDW remains high I would recommend a peripheral smear view by a hematopathologist to look for morphology of your red cells. Also,if you are iron studies have not been done, i would recommend serum iron,transferrin iron binding capacity and transferrin receptor assays.
About your shoulder pain I would advice you to consult a rheumatologist and know more why is it happening. sometimes chronic joint diseases like rheumatoid arthritis can cause changes in blood count and increase your RDW and platelet count along with lowering hemoglobin mildly.
Another issue is your lymph nodes. If you find your lymphnodes enlarged again I would advice you to get them biopsied, if they persist for more than 1 week. Most of the times they are reactive and due to the flu like infections you had.
The 3rd issue is platelet count. It can go high with iron deficiency anemia in most of the patients. However, if it goes beyond 600-650 I would advice a peripheral smear and then a bone marrow examination to rule out the causes of thrombocytosis.
All in all, nothing to worry about right now and my recommendations would be
1)Continue iron tablets you have been taking and eat food rich in iron like spinach.
2)Consult a Rheumatologist and get your shoulder pain evaluated if it is still occuring and get a lymph node biopsy if they again become enlarged for more than 1 week.
3)Repeat a blood test after 3 weeks and if the RDW is still high and/or platelet counts are still going higher-First request a hematopathologist to have a look at your bloods peripheral smear and then if needed a bone marrow study.
4)Concomitantly, iron studies and markers of inflammation like ESR and CRP to rule out chronic inflammation.
5)Also if you have noticed excessive bleeding during periods recently my recommendation to consult a gynecologist.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Hi I would advice joint examination and repeat blood test,peripheral smear
Detailed Answer:
Hi, I did review your concern mam.
Your RDW is increasing and with a normal hemoglobin count it should ideally mean very early iron deficiency anemia or anemia of chronic disease.(Hemoglobin should be low, but not necessarily in very early phase of the problem). In a young female that is generally either due to excessive menstrual bleeding or diet poor in iron rich food. Early iron deficiency anemia can lead to normal hemoglobin but high RDW and low MCV. If still the RDW remains high I would recommend a peripheral smear view by a hematopathologist to look for morphology of your red cells. Also,if you are iron studies have not been done, i would recommend serum iron,transferrin iron binding capacity and transferrin receptor assays.
About your shoulder pain I would advice you to consult a rheumatologist and know more why is it happening. sometimes chronic joint diseases like rheumatoid arthritis can cause changes in blood count and increase your RDW and platelet count along with lowering hemoglobin mildly.
Another issue is your lymph nodes. If you find your lymphnodes enlarged again I would advice you to get them biopsied, if they persist for more than 1 week. Most of the times they are reactive and due to the flu like infections you had.
The 3rd issue is platelet count. It can go high with iron deficiency anemia in most of the patients. However, if it goes beyond 600-650 I would advice a peripheral smear and then a bone marrow examination to rule out the causes of thrombocytosis.
All in all, nothing to worry about right now and my recommendations would be
1)Continue iron tablets you have been taking and eat food rich in iron like spinach.
2)Consult a Rheumatologist and get your shoulder pain evaluated if it is still occuring and get a lymph node biopsy if they again become enlarged for more than 1 week.
3)Repeat a blood test after 3 weeks and if the RDW is still high and/or platelet counts are still going higher-First request a hematopathologist to have a look at your bloods peripheral smear and then if needed a bone marrow study.
4)Concomitantly, iron studies and markers of inflammation like ESR and CRP to rule out chronic inflammation.
5)Also if you have noticed excessive bleeding during periods recently my recommendation to consult a gynecologist.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your reply. I will most definitely follow your suggestion
My iron results were:
IRON BIND CAP (TIBC) 412
UIBC 395
IRON SERUM 17
IRON SATURATION 4
Also my hemoglobin results were normal
HGB SOLUBILITY Negative
HGB F 0.0
HGB a 97.8
HGB S 0.0
HGB c 0.0
HGB a2 2.2
My iron results were:
IRON BIND CAP (TIBC) 412
UIBC 395
IRON SERUM 17
IRON SATURATION 4
Also my hemoglobin results were normal
HGB SOLUBILITY Negative
HGB F 0.0
HGB a 97.8
HGB S 0.0
HGB c 0.0
HGB a2 2.2
Brief Answer:
Can you please send me the iron status report with units
Detailed Answer:
Hi XXXXXXX
Thank you for providing me with the information.
Its nice to know your hemoglobin status is normal.
Can you please send me the actual report of your iron studies by uploading it?
I am asking it because I wanted to know the units used by the laboratory in giving the values since every lab uses different units and reference values and I need to analyze accordingly.
The TIBC seems to be on a higher side, but again i need to correlate with the reference value and the units used for reporting.
If you are not able to upload you can send it to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai' and i can then analyze it properly.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Can you please send me the iron status report with units
Detailed Answer:
Hi XXXXXXX
Thank you for providing me with the information.
Its nice to know your hemoglobin status is normal.
Can you please send me the actual report of your iron studies by uploading it?
I am asking it because I wanted to know the units used by the laboratory in giving the values since every lab uses different units and reference values and I need to analyze accordingly.
The TIBC seems to be on a higher side, but again i need to correlate with the reference value and the units used for reporting.
If you are not able to upload you can send it to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai' and i can then analyze it properly.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Shanthi.E
Attached are the results that you requested. Again, Thank You for your help!
Brief Answer:
The iron studies are trending towards iron deficiency anemia
Detailed Answer:
Hi XXXXXXX
Thank you for the report.
The iron studies are trending towards iron deficiency in your body.
It could be due to either low iron intake or chronic blood loss as we discussed before.
So take iron tablets regularly and you can even ask the pathologist to take a blood sample and do a reticulocyte count after some days. If it is increasing it is an early indicator of good iron response.
If your iron studies and RDW and hemoglobin levels do not respond to iron therapy even after a month then-
1) Chronic small amount of bleeding from excessive menstrual flow/gastrointestinal bleeding may be the cause-so consult a gynecologist and get a stool test done for Occult blood.
2) If no bleeding source present, then my advice would be to consult a hematopathologist and if possible get a peripheral smear viewed by him and if needed a bone marrow study to rule out rarer causes of anemia that can present same as above but require different treatment like sideroblastic anemia.
Since your hemoglobin profile is great we are not worried about any hemoglobinopathies.
Your inflammatory markers like CRP and ESR are also normal, yet if you still have that joint pain that needs to be addressed separately by a rheumatologist and needs to be treated accordingly.
These advises are only for future. Right now there is nothing to worry about your RDW and continue taking iron tablets and eating iron rich food in your daily diet.
These should suffice in most case scenario.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best XXXXXXX
Sincerely,
Dr Parth Desai
The iron studies are trending towards iron deficiency anemia
Detailed Answer:
Hi XXXXXXX
Thank you for the report.
The iron studies are trending towards iron deficiency in your body.
It could be due to either low iron intake or chronic blood loss as we discussed before.
So take iron tablets regularly and you can even ask the pathologist to take a blood sample and do a reticulocyte count after some days. If it is increasing it is an early indicator of good iron response.
If your iron studies and RDW and hemoglobin levels do not respond to iron therapy even after a month then-
1) Chronic small amount of bleeding from excessive menstrual flow/gastrointestinal bleeding may be the cause-so consult a gynecologist and get a stool test done for Occult blood.
2) If no bleeding source present, then my advice would be to consult a hematopathologist and if possible get a peripheral smear viewed by him and if needed a bone marrow study to rule out rarer causes of anemia that can present same as above but require different treatment like sideroblastic anemia.
Since your hemoglobin profile is great we are not worried about any hemoglobinopathies.
Your inflammatory markers like CRP and ESR are also normal, yet if you still have that joint pain that needs to be addressed separately by a rheumatologist and needs to be treated accordingly.
These advises are only for future. Right now there is nothing to worry about your RDW and continue taking iron tablets and eating iron rich food in your daily diet.
These should suffice in most case scenario.
I hope this helps.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best XXXXXXX
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Prasad
Hello Dr. Parth:
I had a reticulocyte count blood test performed in April. My results were 1.3 where the standard range was 0.6-2.6%. What does this suggest? And does it rule anything out? Also, I did have an MRI of my abdomen to follow-up on the liver lesion that has grown. On the basis that everything with the MRI comes back normal, what will that suggest? Can anything be ruled out with that?
I went to visit another doctor on Friday. He changed my dosage of Vitamin D and Iron because he said the dosage I was taking was not going to do anything for me. He said that I will feel much better once those levels return to normal. He also said that he could ensure me that it is not lymphoma or leukemia based on past blood work and office exam (touch toes, etc.). So at this point I don't really know what to do next. I suppose I will follow up with my GI doctor once I receive the MRI results.
I had a reticulocyte count blood test performed in April. My results were 1.3 where the standard range was 0.6-2.6%. What does this suggest? And does it rule anything out? Also, I did have an MRI of my abdomen to follow-up on the liver lesion that has grown. On the basis that everything with the MRI comes back normal, what will that suggest? Can anything be ruled out with that?
I went to visit another doctor on Friday. He changed my dosage of Vitamin D and Iron because he said the dosage I was taking was not going to do anything for me. He said that I will feel much better once those levels return to normal. He also said that he could ensure me that it is not lymphoma or leukemia based on past blood work and office exam (touch toes, etc.). So at this point I don't really know what to do next. I suppose I will follow up with my GI doctor once I receive the MRI results.
Brief Answer:
Keep taking iron tablets at higher dose and repeat blood test after 1month
Detailed Answer:
Hi I did review your reply query XXXXXXX
Your reticulocyte count is in normal range so it rules out anything like aplastic anemia or hemolytic anemia where it can be low or high.
Your liver lesion as likely suggested due to oral contraceptive pills would most likely be an adenoma which regresses some time after the stopping the birth control pills. It generally should not have any relation to your anemia, unless it shows signs of inflammation.
Taking higher doses of iron and vitamin D will not harm you much unless you have problems like gastric upset or headache when you should consult your doctor.
TO rule out leukemia or lymphoma, the best approach apart from office exam would be a peripheral blood smear examination. However, with your report the chances are very very low as platetet count is normal or on slightly higher side at maximum/
Yes once the hemoglobin levels normalize you will start feeling much better.
However, I would advice you to repeat the blood test after 1 month and if still the hemoglobin has not risen after 1 month iron tablet course then I would advice you to get evaluated in detail for chronic small bleeding-which is mostly from bowel sites.The best test for that would be stool test to find out occult blood.
SO all in all,
All your steps look fine.
1)Continue Iron tablets and vitamin D and get a blood work up after 1month. This time preferrably with a morphological review of your peripheral blood cells. (You can ask specifically to the pathologist or your doctor for that).
2)Repeat iron studies to see replenishment of iron stores.
3)If hemoglobin not corrected and iron studies show similar or lower results, evaluation for causes of small amount bleeding is needed-bowel sites-stool test for occult blood.
4) If you still have shoulder pain or other joint pain, I would recommend a thorough examination by a doctor for that preferrably by a rheumatologist.
5) If your lymph nodes swell up again and remain large, a biopsy or fine needle aspiration cytology (FNAC) is needed to see the type of cells it is made up of.
6) Follow up with your GI doctor to keep reviewing your liver lesion and its regression.
I hope this helps. Thank you for your reply
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Keep taking iron tablets at higher dose and repeat blood test after 1month
Detailed Answer:
Hi I did review your reply query XXXXXXX
Your reticulocyte count is in normal range so it rules out anything like aplastic anemia or hemolytic anemia where it can be low or high.
Your liver lesion as likely suggested due to oral contraceptive pills would most likely be an adenoma which regresses some time after the stopping the birth control pills. It generally should not have any relation to your anemia, unless it shows signs of inflammation.
Taking higher doses of iron and vitamin D will not harm you much unless you have problems like gastric upset or headache when you should consult your doctor.
TO rule out leukemia or lymphoma, the best approach apart from office exam would be a peripheral blood smear examination. However, with your report the chances are very very low as platetet count is normal or on slightly higher side at maximum/
Yes once the hemoglobin levels normalize you will start feeling much better.
However, I would advice you to repeat the blood test after 1 month and if still the hemoglobin has not risen after 1 month iron tablet course then I would advice you to get evaluated in detail for chronic small bleeding-which is mostly from bowel sites.The best test for that would be stool test to find out occult blood.
SO all in all,
All your steps look fine.
1)Continue Iron tablets and vitamin D and get a blood work up after 1month. This time preferrably with a morphological review of your peripheral blood cells. (You can ask specifically to the pathologist or your doctor for that).
2)Repeat iron studies to see replenishment of iron stores.
3)If hemoglobin not corrected and iron studies show similar or lower results, evaluation for causes of small amount bleeding is needed-bowel sites-stool test for occult blood.
4) If you still have shoulder pain or other joint pain, I would recommend a thorough examination by a doctor for that preferrably by a rheumatologist.
5) If your lymph nodes swell up again and remain large, a biopsy or fine needle aspiration cytology (FNAC) is needed to see the type of cells it is made up of.
6) Follow up with your GI doctor to keep reviewing your liver lesion and its regression.
I hope this helps. Thank you for your reply
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
An In office exam will be a different test.
Detailed Answer:
Hi, thank you for your question mam.
MRI will show bowel and colon areas but it depends on the radiologist what image modality he uses to see the liver lesion. Generally, they do review the whole abdomen with special focus on region of interest. For bowel MRI gives a good picture for OUTSIDE of bowels and how they are looking like.
An In office exam if includes barium studies or endoscopy and a fecal occult blood test can find more details about colon and rectum and is a good supplementary test. It is more focused on what is happening on the INSIDE of the bowels in simplest of terms. It depends on the doctor which test he wants to perform first and how he goes about it, but I suppose it will help to detect any major problem in your bowel if it is present.
I hope this helps. Thank you for your reply
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
An In office exam will be a different test.
Detailed Answer:
Hi, thank you for your question mam.
MRI will show bowel and colon areas but it depends on the radiologist what image modality he uses to see the liver lesion. Generally, they do review the whole abdomen with special focus on region of interest. For bowel MRI gives a good picture for OUTSIDE of bowels and how they are looking like.
An In office exam if includes barium studies or endoscopy and a fecal occult blood test can find more details about colon and rectum and is a good supplementary test. It is more focused on what is happening on the INSIDE of the bowels in simplest of terms. It depends on the doctor which test he wants to perform first and how he goes about it, but I suppose it will help to detect any major problem in your bowel if it is present.
I hope this helps. Thank you for your reply
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I have sent you an email with latest blood work results. Wasn't sure if it was a peripheral smear or not...
Brief Answer:
I will review the blood report as soon as I get it and get back
Detailed Answer:
Hi, thank you for your reply.
I have not yet received the blood work result. You can upload it here like the iron report you uploaded before. Or you can send it to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai'.
I will be waiting for your reports.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
I will review the blood report as soon as I get it and get back
Detailed Answer:
Hi, thank you for your reply.
I have not yet received the blood work result. You can upload it here like the iron report you uploaded before. Or you can send it to YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai'.
I will be waiting for your reports.
Please let me know if you have any questions or concerns. i will be more than happy to help you. Also please provide me feedback about your health and test results.
Wish you all the best.
Sincerely,
Dr Parth Desai
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Raju A.T
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