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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6822
Experience:  14 years as clinician in the field of Family Practice
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A CBC including Total complement, c3, c4 and rh quant were

Customer Question

A CBC including Total complement, c3, c4 and rh quant were done following a subconjunctival hemorrage of the eye and sudden peteachaie (overnight hundreds on trunk and legs, though pinprick size). Results showed likely iron deficiency anemia as hemoglobin was 9 and rbw high 18.8. I have had this issue before due to heavy menstruation. My c3 and c4 were within normal ranges, as was rh quant, though at 20 was one point below mild rheumatoid arthritis. However my CH50 was 320. I've had recurrent numbness in left foot and splaying of toes and obvious, I assume ganglion cysts in both feet that are visible, and appear to be multi stalked. Though no sign of arthritis in hands. Recently had an elbow infection with swelling and was checked for gout that came back negative. Would you suggest any further blood testing to narrow down ongoing issue, (since hemorrhage have felt fluish with low grade fever 99.4 on average and swollen glands in neck though tested negative for strep just to make sure.) Several female relatives have had rheumatoid arthritis and was wondering if this is a possibility still? AHA screen was negative. Please advise if next step would be rheumatologist or hemotologist?
Submitted: 10 months ago.
Category: Health
Expert:  Anthony Bray, MD replied 10 months ago.

Anthony Bray, MD : Hello!
Anthony Bray, MD : Hmmm how much of this petechiae occurred?? One time only or more than one ??
Anthony Bray, MD : have you had fever??
Anthony Bray, MD : any known tick exposure ??
Anthony Bray, MD : pletelets on your CBC I presume we're normal??
Anthony Bray, MD : possible benefit from your history to see hematologist ...
Anthony Bray, MD : Also possible benefit to further consult rheumatologist --- type of vasculitis affecting small arteries possible cause here...
Anthony Bray, MD : certain infections may cause petechiae -- RMSF - typically associated with tick bite-- fever/ headaches / needs treatment right away if this cause...
Anthony Bray, MD : subacute bacterial endocarditis as cause possible --- you would typically notice marked fatigue / shortness of breath / often may follow dental procedures/ I would do series of three sequential blood cultures to check for bacteremia ....
Anthony Bray, MD : certain viral infections may cause but would tend to suspect significant illness otherwise with these....hantavirus virus can be hemorrhagic but you would be very ill with that for example...
Anthony Bray, MD : anyone else with illness ??
Anthony Bray, MD : 99.4 is technically not fever ... 98.6 plus or minus 1.3 degrees is normal range....
Customer:

blood pressure 134/95, 133/85. Eye doctor is the one who requested cbc.

Anthony Bray, MD : Follow up with rheumatologist and perhaps dermatologist may be helpful ... I more suspect a type of vasculitis ... A biopsy of skin at area if active lesions may help reach your diagnosis...
Customer:

I guess my concern was if CH50 can be high as a fluke or no real underlying cause?

Anthony Bray, MD : it could be related to immune complex disease... Kidney function and check for small amount of blood in the urine would be good idea in this circumstance ...
Anthony Bray, MD : certain autoimmune process could cause this but have negative ANA... Would check sed rate and c- reactive protein...
Anthony Bray, MD : I see--- blood pressure should be monitored as you had some high readings there ... Rest and check seated pressures at hone ( buy cuff at pharmacy) average if 10 plus numbers should see 100- 135/ 60 - 85 on average... Average is the key !!
Anthony Bray, MD : Did you have retinal hemorrhages as well? Or scleral hemorrhages? ( white if the eye affected ??)
Anthony Bray, MD : So I would recommend the follow up tests as described as being helpful to your case .... Skin biopsy I think would be helpful test here...
Anthony Bray, MD : i hope this information is helpful ... Let me know if you have further questions and I will be happy to get back with you!!
Customer:

Can you sometimes have ch50 as high and it be insignificant?

Anthony Bray, MD : I think it is relavent to your cause... It shows activation of your immune system but it is still nonspecific... Could be infectious cause or autoimmune in nature...
Anthony Bray, MD : the CH 50 is significant result and relavent I agree but unfortunately it still leaves wide range of possible causes...
Customer:

subconjuntival hemorrhage, white of eye only happened once but same day as coincidental petachaie burst I noticed that morning. full trunk down to mid thigh. very small, but some larger.

Anthony Bray, MD : Blood cultures and other tests for infection would be helpful potentially .... Testing for IGG/ IGA /IGE and IGM antibodies may be helpful...
Anthony Bray, MD : have you recently started any new medicines??
Anthony Bray, MD : no pain?
Anthony Bray, MD : sounds potentially consistent with leukocytoclastic vasculitis --- if this then course of prednisone may be potentially helpful...
Anthony Bray, MD : pattern of petechiae would be helpful to know-- stable?? Getting better?? Getting worse???
Customer:

no medicines. I only take ibuprofin maybe four times a year. Other than occasion valerian root for sleep, no other meds. I'm supposed to be taking iron as seem to be anemic but aren't at all consistent with it.

Anthony Bray, MD : thus pattern would strongly determine your needed direction....
Anthony Bray, MD : Yes hemoglobin of 9 is too low ... Most common cause is low iron and usually related to chronic blood loss... GI blood loss ( occult) should be ruled out... ??? Do you have heavy menstruated cycle blood loss = possible cause...
Anthony Bray, MD : ferrous sulfate325 mg/ day -- this or other iron supplement--- take with vitamin C 500 mg/ day
Anthony Bray, MD : the vitamin C is helpful to improve iron absorption...
Customer:

About three times in the last year 1/2 will notice suddenly large amounts of fresh red petechiae as getting dressed in the morning, but will slowly fade to a darker color. Just noticably, very large amounts and suddenly. Have had shortness of breath, periodic heart palpitations I always attributed to anemia cause of heavy menstruation. 10 days. was diagnosed with fibroids about 5 years ago. I assumed all causes were related to stress, anemia until eye thing happened. Was too coincidental with the petechaie I noticed earler in the morning. Just put two and two together.

Anthony Bray, MD : Well you do need to get the anemia and iron deficiency corrected -- normal hemoglobin should be at least > 12 so your heart has to work 25 % greater to get oxygen to tissues... The long periods between events to me sounds likely consistent with leukocytoclastic vasculitis -- this is propagated by immune system but various triggers exist if this is your cause....
Anthony Bray, MD : So I do advise further follow up and investigation until petechia clear and iron level and hemoglobin return to normal...
Anthony Bray, MD : sometimes hormonal changes can trigger... You don't take birth control pills??
Anthony Bray, MD : The long period of time between delayed events with the petechia sounds consistent with some trigger if your immune response as likely underlying cause... Not any ongoing infection for 1.5 years....
Customer:

Went to eye doctor for eye, and had physical cause I hadn't had one in 5 years. Yes, I have appt.Friday at doctor cause of dermatofroma on leg had been removed and regrew and looked suspicious on a spot ultrasound my doctor did, (after I mentioned it had been painful and growing) she noticed cysts on my feet then. Had mri on leg and doctor thought dermatofibroma looked benign but had a lot of inflammation in the leg so and multiple cysts in and about my foot/ankle etc. not seen or felt. just was curious since they didn't really answer a lot of my questions. argh. Said probobly have multiple things going on. Will biopsy site and took xrays of the leg after mri and will give me results friday. Afraid all of this is benign and after 5 years of not seeing doctor will be getting concerned over nothing. No don't take brith control pills.

Customer:

tubes are tied after 4 kids/csections!

Anthony Bray, MD : I see... You mentioned ganglion cysts at One point and if this that dinging would seem harmless and unrelated to problem...
Anthony Bray, MD : your nutrition good?? No starvation diet?? Here I wonder of vitamin C deficiency as possibly related ... It can cause petechiae...
Anthony Bray, MD : weak connective tissue could be possible link between petechiae and ganglion cysts but this seems like a reach!!
Anthony Bray, MD : Good healing of skin promoted by both vitamin C 500mg/ day and zinc 50 mg/ day .... Would not hurt...
Customer:

No starvation at 5 ft. tall and 140 lbs!. Lots of rheumatoid arthritis in family line, could that still be possibility if rh is 20, close to 21 (mild sign).

Anthony Bray, MD : Well I don't think rheumatoid arteries per se would cause but autoimmune class -- yes -- certainly may be cause---
Anthony Bray, MD : Creactive protein/ sed rate/ ANCA/ protein C / protein S / platelet function may be worth considering...
Customer:

Just assumed I was an old fatty with bad feet. k, well thanks. But back to the first and main question- Do you ever see CH50 at around 320 and it be nothing, just a fluke? That was my main concern, since I am being treated. I assume my immune system is poor. High stressed person and had shingles 8 years ago.

Customer:

No more questions after that.

Anthony Bray, MD : Arthritis I meant to say above !!
Anthony Bray, MD : It is an abnormal result but meaning if this one result is too broad!! I can't say too much with that except to acknowledge that the immune system was triggered into high gear. I suspect a recheck would show more normal result now ...
Anthony Bray, MD : A viral infection of a certain type may be your trigger to cause your vasculitis and petechiae --- that is scenario that I would most suspect at this point...
Customer:

k good. Thanks.

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6822
Experience: 14 years as clinician in the field of Family Practice
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