What Does This Checkup Reports Showing Low Hemoglobin Indicate?
My wife XXXXXXX is 45 years old. During her checkups today, following abnormalities have been found:
CBC:
RBC Count 5.08
MCV 72.40
MCH 22.80
MCHC 31.50
RDW 16.10
TLC 11.06
Eosinophils 0
Neutrophils 7.47
LFT / KFT:
ALP 126.00
Total Protien 5.90
Albumin 3.30
Calcium, Total 8.60
Serum Vit B-12 (Cynocobalamin) 1353.3
HbA1c 6.70 (last year it was 6.30)
BG (fasting) 111.5 (all pervious tests used to be normal)
BG (PP) 191 (all previous tests used to be normal)
Other parameters are within range.
In USG done in Feb'13, Spleen was found enlarged in size with craniocaudal dimension of 14.15 cms
That time (Feb'13)Haemoglobin chromatography HPLC was found normal. Reticulocyte count, B-12 and Serum Lactate Dehydrogenase were also normal.
I am worried about my wife. Does these abnormalities indicate some serious problem? What action we need to take?
Thanks for your advice
XXXXXX
I need more details.
Detailed Answer:
Dear Mr XXXXXX
Hi , I am Dr Anshul Varshney , I have read your query in detail , I understand your concern.
I have personal affection in solving such medical issues, that remain undiagnosed. So, i am keen to help you in your case.
I would be glad if you could attach the reports here by scanning them, because i want to see the reference range of these tests of your laboratory, as it varies from lab to lab.
In general i have reviewed her reports with standard reference range.
You have not mentioned her Hemoglobin level (Hb).
The current investigations suggest that she has Anemia and that too Microcytic Hypochromic type, that can be due to Iron deficiency, Thalassemia, Sideroblastic anemia.
Another point of concern is her Spleenomegaly. That favours Chronic Anemia.
Moreover, her Serum Albumin is also slightly less.
Her blood sugar levels and HbA1C are in diabetic range.
With these details, i would like to rule out following conditions:
1. Cause of her Anemia.
2. Chronic Liver Disease (because of increased spleen and low albumin level).
3. Malabsorption syndrome like Celiac disease.
4. Hemochromatosis.
5. Wilson's disease (in case we explain the spleenomegaly with Chronic liver disease) as she has Schizophrenia (they are interlinked).
I would like to know following details:
1. Her Hemoglobin, Platelet Count, Serum Creatinine, Urine Routine. I would appreciate if you could attach all reports, i would study them my way.
2. What problems does she has?
3. Any history of excessive loss of blood in her periods (even in past)
4. Any history of bony pains?
5. Any history of chronic / frequent loose stools? Pain abdomen? Indigestion?
6. Any history of any illness in her parents?
7. Any history of alcohol consumption?
8. Any history of any visual disturbance?
9. What does her Ultrasound say about Liver? Please attach the report.
This is my personal opinion based on details available here. If you still have any other query, you may please ask me and answer these questions preferably in point wise manner.
Stay Healthy.
Dr Anshul Varshney , MD
Thanks for your reply. I give point wise information as follows:
1) All reports of 2013 and recent are attached herewith. Urine report of today is also attached which is normal.
2) Apparantly, she has no problem except occasional fatigue. As such, her lifestyle is sedentry due to psychatric medicines
3) No history of excessive bleeding or loss of blood during periods
4) No bony pains
5) She has more constipated stomach and tight stool and never loose. She has ocassional acidity
at the age of 60 due to lungs failure attributed to chronic asthma
7) No alcohol consumption
8) No known history of visual disturbances
9) She has thyroid problem and is on Eltroxin for last 25 years. The dose gets adjusted due to fluctuating TSH which gets higher and lower than normal.
Kindly go through the reports and advice.
Thanking You
XXXXX
Detail Follows
Detailed Answer:
Dear Mr XXXXXX
I have reviewed your all reports.
I appreciate your efforts to keep her in good health.
Here i would say, that i find following problems in her reports:
1. Diabetic Range Blood Sugar - She should start on treatment. In such situation i prefer to start my patient on Metformin.
2. Slightly lower Hemoglobin as compared to previous one. But the work up has been done and no cause has been found. Moreover, a slight difference can occur from laboratory to laboratory.
3. Subclinical Hypothyroidism- With the available reports, there is no indication to start her on Thyroxine. Guidelines state that in asymptomatic patient, Eltroxin should be started only when TSH level is >10. Otherwise 6 monthly follow up is just required.
4. Spleenomegaly- This is my main point of concern. The all above diagnosis that i have kept, are based on spleenomegaly. But again, it can be found enlarged in few people. In case if ever she has got her Ultrasound done, and spleen was normal in size then, there is indication for further workup. Also, if your doctor finds on clinical examination presence of spleen, then we need to do further investigations.
Here clinical examination plays the most important role. I can not examine her here, so i can just advise you.
In addition , i would also advise following:
1. To get her a repeat Ultrasound from another centre.
2. To give her Anti Helminthic treatment if not given, that is Mebendazole/Albandazole.
3. To give her Vitamin D3 XXXXXXX 60 k 1/week.
4. If she is overweight, promote her for weight loss, for a better diabetic control.
If you have any further query, you may please ask me.
Dr Anshul varshney, MD
1) As advised by you, today XXXXXXX got fresh USG done and report is uploaded here
2) Kindly check the report and suggest if any further investigation is required for the spleen
3) Can we start the medicines and Vit D3 suggested by you?
4) I was curious to know your location and if it is XXXXXXX would like to consult you in person
Thanking you again
XXXXXX
Detail Follows.
Detailed Answer:
Dear Mr XXXXXX.
In her new Ultrasound also, her spleen is slightly enlarged.
But, there are no signs of any Chronic Liver Disease, that can cause spleenomegaly.
Since she has been investigated for Chronic Anemia and diseases like Thalassemia that can cause spleenomegaly, so i think we can take a break here.
I mean to say, let us give her treatment first and see the response now. As she must also be sick of testing now!!
I would currently implicate her splenomegaly to her Nutritional Anemia.
In case, she also suffers from Chronic Fever, let me know.
So, i would advise you to follow as i have advised in my last answer.
Following are answers of your last query:
1. I appreciate for getting her ultrasound promptly, i have reviewed that.
2. Nothing to be done at present, start her on Iron supplements and Multivitamins. Promote her to eat good , healthy nutritious food. In case she would have persistent anemia, we would do workup for Celiac disease.
3. Vitamin D3 can be given safely to her. If you wish you can get her 25, Hydroxy Vitamin D3 Levels, i assume they would be low, if she is not on any Calcium or Vitamin D3 supplement already.
4. I have my clinic in XXXXXXX If ever you wish to see me in person you can contact me through my email id YYYY@YYYY for appointment.
Also, I am always available for you through Healthcaremagic, you can anytime go to my page and ask me a direct query.
I hope all these things would help you, and i wish that Mrs. XXXXXXX feels fit and fine and lives a healthy and happy life.
If you have any further query, please ask me, else you may please close the discussion and rate it!
Stay Healthy.
Dr Anshul Varshney, M.D.