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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33529
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hi, I was just in the hospital for chest pain. They ruled

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Hi, I was just in the hospital for chest pain. They ruled out acute coronary syndrome, but I had an increased MCV of 104, decreased MCHC, increased RDW, and increased MPV. Also, monocytes are increased and white blood cell count went from 7 to 9.5 in 6 hours. I also had an increased chloride and a decreased CO2, and they discharged me before finding the cause of my pain. Don't know about this blood work, but my vit B12 has been normal, as has been my iron and folic acid. I take women's vitamins also. I am a bit achy too.

Hello Cathy,
I am Dr. Arun and will be helping you today.

How severe is / was your chest pain?
Do you have cough, fever, shortness of breath, nausea, heartburn, food reflux?
Are you a smoker. overweight?
Any significant past medical illness or surgery?
What are your medications apart from Baclofen?

Customer: replied 3 years ago.

Hi Dr.


The chest pain was under my left breast. It was very bad, about 7 to 8 out of 10, intermittent, and squeezing in sensation, not sharp. It was deep, not superficial and not tender to palpation. It didn't hurt with moving or breathing or coughing. I've had heartburn, no fever, no shortness of breath. I have had some coughing but not much. I'm a smoker trying to quit smoking about 1/2 pack per day, but used to smoke much more. I am starting the patch now. I am a little overweight, 155 pounds 5 feet 3 inches. I have had hypertension, but my blood pressure in the hospital was very low. I have sleep apnea, stable. I have multiple sclerosis, stable. I have hypothyroidism, stable. I have a history of nonobstructive coronary artery disease and supraventricular tachycardia. I also have a history of bipolar disease and mild COPD that is asymptomatic. The bipolar disease is stable on medication. I take Pristiq and Abilify, Aubagio for MS, metoprolol and Norvasc, potassium, topamax for pain, Vyvance, levothyroxine, pravachol, Klonopin, amantadine, Exelon patch and that's about it. I do take an inhaler (Symbicort) and do use a CPAP machine. I am legally blind and have had several surgeries on my eyes, a hysterectomy, lipoma removals, tubal ligation, lumpectomy, and tooth extractions. That's about all I got. Thanks.


You are welcome, Cathy.

Thanks for the detailed reply. Your symptoms are suggestive of non cardiac chest pain. The most common causes are;

1) Esophagus movement disorder
2) Hiatal hernia
3) Gastroesophageal reflux disease.

A barium esophagogram and 24 hours manometry with esophagus pH study are diagnostic for these conditions apart from upper gastrointestinal endoscopy. Please read about it;

Pinched nerves in neck can cause radiculopathy pain and muscle spasm too may cause severe chest pain. Acute bronchitis which can be viral or allergic may also be responsible for your pain and present investigative findings.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.


Dr. Arun Phophalia and 2 other Health Specialists are ready to help you
Customer: replied 3 years ago.

Would like to know what it means to have an increased MCV, increased RDW and increased MPV all at once? Isn't that kind of strange?

Hello Cathy,

The investigations are corroborated and interpreted in the context of;

1) symptoms
2) signs
3) physical exam findings
4) other investigations.

So investigations are usually not important in isolation. These are collectively able to point towards a diagnosis or rule out anything going abnormal or serious.

When the body produces increased numbers of platelets, the size of the average platelet increases, MPV is used to look at platelet output by the bone marrow. It helps along with other measurements to assess between hyperdestructive thrombocytopenia (actual destruction of platelets "normally" produced by the bone marrow) as in idiopathic thrombocytopenia purpura v/s hypoproductive thrombocytopenia. It is also being looked at as an indice in heart disease and diabetes as a predictor of stroke. A mild raise of MPV may not be important clinically to diagnose a medical condition, especially if there are no other corroborative investigative findings. Established cardiovascular risk factors, such as smoking, hypertension, dyslipidemia, and diabetes, can influence MPV, depending on confounding factors. Low-grade inflammation is one such factor. Evidence, particularly derived from prospective studies and a meta-analysis, suggest a correlation between a significant increase in MPV and the risk of thrombosis. A mild increase in MPV may be without any serious cause.

Mean corpuscular volume (MCV) is the average volume of red cells.

The common causes of macrocytic anemia (increased MCV) are as follow

Folate deficiency
Vitamin B12 deficiency
Liver diseases
Hemolytic anemia (red blood cell destroying due to some cause)
Low thyroid (Hypothyroidism)
Excessive alcohol intake

Red cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. since RDW is mathematically derived from MCV, it is therefore affected by the average RBC size (MCV). Elevated RDW helps provide a clue for a diagnosis of early nutritional deficiency such as iron, folate, or vitamin B12 deficiency as it becomes elevated earlier than other red blood cell parameters.`

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