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Nurse Susan
Nurse Susan, Nurse (RN)
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Experience:  RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
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Just got blood test results. WBC is Low at 3.9, MCV is High

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Just got blood test results. WBC is Low at 3.9, MCV is High at 104, MCH is High at 34.7
B12 and Folate levels are normal at 627 and >19.9, respectively. What does that mean since it doesn't appear to be B12 or folate deficiency?
Submitted: 4 years ago.
Category: Health
Expert:  Nurse Susan replied 4 years ago.

Hello Jacustomer,

 

Id like to be able to help you, but need some more information.

Were these the only abnormals that you had? What were your RBC count? What was your hemoglobin (Hgb) and hematocrit (Hct)? The WBC, was a differential done? (The different types of white blood cells). Were those levels normal, or were there any abnormal values within the white blood cell numbers themselves?

 

Thank you for clarifying,

Sincerely,

Susan

Customer: replied 4 years ago.

These were the only abnormal (out of reference interval) readings.

RBC = 3.86

Hgb = 13.4

Hct = 40.0

 

Expert:  Nurse Susan replied 4 years ago.

Hello Jacustomer,

 

My reply to you is going to be rather detailed and will take some time to type. I thank you for your patience. One other thing...every lab has different ranges of normals. What are the ranges of normal your lab gives for your Hbg and Hct?

 

Thank you,

Sincerely,

Susan

Customer: replied 4 years ago.

No problem - no rush...

Lab ranges are:

Hbg - 11.5 to 15.0

Hct - 34.0 to 44.0

 

One other reading that is on the edge is neutrophils - reading was 1.8 against an interval of 1.8 to 7.8

 

Thanks!

Expert:  Nurse Susan replied 4 years ago.

Hello Jacustomer,

Thank you for providing this information. Lab results can be confusing but I will try to explain yours; of course, the final interpretation and diagnosis is your doctors.

 

The WBC is your white blood cell count. It is the white blood cells that protect and defend the body against germs and bacteria. Different labs have different references ranges of normal. The white blood cells are measured by 4-8 X 10(3) millimoles cubed. That means for every millimole, which is a very small number of measure, there should be at least 4000-8000 white blood cells. YOURS were 3,900, which is a little on the low side. Low total white blood cell counts can be because of medications, some viruses, cancer treatments and some problems with bones. Of course, I don't know which, if any, of these situations apply to you.

 

There are different types of white blood cells, and your blood test tested for each specific type, and that number is XXXXX as a percentage of the whole total of white blood cells.

NEUT stands for Neutrophils, and they specialize in fighting off bacterial infections. Yours were normal.LYMPH stands for lymphocytes, which specialize in fighting viral infections. Again, yours were normal. BASO stands for basophils which specialize in fighting parasitic infections. Your levels were normal. EO stands for eosinophils, and they specialize in allergic responses. Again, yours were normal. MONOCYTES (MONO) specialize in severe infections. Your levels of this were normal.

 

The RED BLOOD CELLS (RBC) help carry oxygen to your body's tissues. Your numbers of red blood cells were very slightly lower than they should be, at 3.86. When a person has low levels of red blood cells, we want to know why...so we look to what they do. The HEMOGLOBIN is the chemical which carries oxygen, yours was a nice 13.4, which is normal. The HEMATOCRIT helps determine the mass of the RBC, or what percentage of the blood is made up of red blood cells. Again, yours was normal, at 40.

 

The Mean Corpuscular Volume, or MCV means on average, how BIG are those red blood cells. These numbers are important as YOU had slightly low numbers of red blood cells, and so knowing if the cells are BIG or small will can help tell why there would be lower numbers of them. Your MCV was big, at 104. The most common reasons for the MCV to be increased is a definincy in Vitamin B and folic acid, whether you cant absorb it or because you aren't eating enough of it. But you knew that, and your levels of both were normal. Some parasites can also cause a large MCV.

 

Mean Corpuscular Hemoglobin (MCH) means how much hemoglobin is riding on those red bloodcells. Your cells were larger, thus more hemoglobin can fit on them. Thats why your MCH was a bit elevated at 34.7. This happens in macrocytic anemia (macrocytic meaning large red blood cells, anemia meaning low levels of RBC)

 

There are some other numbers that can help to tell the story of whats happening within your blood.

 

Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in those cells. Yours was normal (I'm assuming all was normal or else you'd have given those numbers as well).

The Red Cell Distribution Width (RDW) tells us how WIDE red blood cells are. Reasons some are wide can include iron defiency anemia.

Your PLATELETS (PLT) are the things that help you clot, so when you injure yourself you don't bleed to death.

 

In essence, you had a slight lowering of red blood cells, and a slight low value of white blood cells. The tests that can help determine WHY you had anemia is is the MCV, and you know already you dont seem to have a folate or B12 defiency, the most common reasons for this type of anemia. So, look to the LESS common reasons.

 

I dont intend to alarm you with this paragraph, but some of these reasons are less than pleasant. Some conditions increase your use of B12 and folic acid, thus making you actually deficient there even when your blood can test normal for the levels. They include chronic pancreatitis, neoplastic disease (which is cancers), pregnancy, and hyperthyroidism. And of course, a tapeworm can cause this type of anemia. Of course I cant state you have ANY of these.

 

What I suggest is you speak to your doctor about the other reasons besides B12 and folate that one can have macrocytic anemia, and test for them as makes sense.

 

I hope I was able to help....

Sincerely,

Susan

Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1085
Experience: RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
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