Why My Anemia Is Quite Low And With No Symptoms ?

Posted on Fri, 27 Sep 2024

Question: Hi, I recently had my annual exam and my CBC was as follows:

RBC: 3.95 range: 4.17-5.75
Hemoglobin : 12.9 range: 12.9-17.0
Hematocrit: 36.4 range: 37.5-50.1
MCHC: 35.4 range: 32.2-35
RDW : 17.3 range 12.2-16.5
Mono: 4.5 range: 5.0-11.6

All other values are normal. I was diagnosed with mild anemia five years ago and my numbers then were lower than this. I had my bloods retaken a month later and they were normal and have been normal for the past five years. Although, I am at the low end of the range of my RBC, usually right on the low reference number, my hematocrit has been low in some past labs and my RDW is usually around 16.3 but has been as high as 19.5 and 18.5 in the past and my values for Mono are always low. I asked my DR about my labs and he said they are fine and my anemia is quite low and with no symptoms he just told me to keep an eye out for black tarry stools, fatigue, and change in bowel habits. I have not had any of those. I wanted another opinion on my labs, do you think my Dr is being dismissive of my labs and not taking them serisouly?

Thank you

Answered by Dr. Shailja Puri (6 hours later)

Brief Answer:
CVC is within normal range

Detailed Answer:
Hello,
I have gone through your complete blood count (CBC) report.
The report shows slightly low red blood cell count, low hematocrit, low MCHC and slightly high RDW.
These parameters do not signify any serious condition.
The CBC can be repeated after six months to look for any fall in hemoglobin.
The differential count for monocytes is slightly low but does not suggest anything abnormal.

If you have any query, I will be glad to answer.
Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Shailja Puri (2 hours later)

Thank you. My DR said the same thing I also have high bilirubin 1.9-2.5 had it all my life. My DR said my bilirubin could cause my anemia. My RDW has been high for 7 years and on 8 of my 10 lab tests. Does the high rdw suggest an iron deficiency? Also what would cause low monocytes? Mine have been low on 4 of my 10 lab tests.

Follow up: Dr. Shailja Puri (13 minutes later)

My MCHC is actually high it’s been high on about half my labs for the past 7 years.

Answered by Dr. Shailja Puri (9 hours later)

Brief Answer:
Iron profile can be done to rule out iron deficiency.

Detailed Answer:
Hello and welcome again,
Since the RDW is on higher side, i suggest you to get iron profile which includes iron, TIBC % saturation and ferritin levels to assess the iron stores.
A low differential monocyte count is not of much concern since the absolute monocyte count is within range.

I hope I have addressed your concerns.
If you have more queries, I will be glad to answer.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Dr. Yogesh D

Follow up: Dr. Shailja Puri (6 hours later)

Thank you would things like aplastic anemia, Meydloysplactic syndrome or sideroblastic anemia be a concern? Also would an internal bleed from a polyp or possible colon cancer cause borderline anemia, or are all of my values too close to normal for any of the above I just mentioned?

Thank you

Answered by Dr. Shailja Puri (40 hours later)

Brief Answer:
CBC values not suggestive of any syndrome.

Detailed Answer:
Hello and welcome again,
Your complete blood count (CBC) report does not suggest any of the mentioned syndromes - aplastic anemia, myelodysplastic syndrome or sideroblastic anemia.
Is there any history suggestive of intestinal polyp like blood in stools etc.
In case there is any history of blood in stools, I suggest you to consult a gastroenterologist.
You can get iron profile done.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Saisudha Kotla

Follow up: Dr. Shailja Puri (7 hours later)

I do not have a history of blood in my stool. On occasion I have had blood on the toilet paper after a hard stool or if I have had multiple bowel movements during the day and my anus is usually sore then and I have a history of hemorrhoid's, I had some last summer that were really bad and painful. I did have anemia 5 years ago like I mentioned and my numbers were lower then and I also had a positive occult test then, but I did not get the results of that test until after I had my CBC redone and everything was normal. My question is could I potentially be losing some blood over a 5 year period, not show anemic on any of my other CBCS before this one and not know I was losing blood?

Answered by Dr. Shailja Puri (3 hours later)

Brief Answer:
Assessment of iron stores and clinical assessment by surgeon required

Detailed Answer:
Hello and welcome again,
History of hard stools, blood in stools, soreness in anal region are all suggestive of piles. or anal fissures.
Blood loss over a period of time can lead to anemia and depletion of iron stores.
The Hb levels is still normal but iron stores need to be assessed.
In case iron level is low, iron supplements can be given to replenish iron stores.
I suggest you to consult a surgeon for clinical assessment and treatment of anal fissures.

Thanks and take care
Dr Shailja Puri

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Above answer was peer-reviewed by : Dr. Nagamani Ng