I am a 40 year old female with no prior health problems. At a routine physical in late June, my primary found my hgb at 8.1 and b-12 of 299, (low mpv, high rdw) Microcytic, hypochromia, anisocytosis = IDA. I have been on 3 iron pills a day and 1000mcg of b12 daily for 10 - 12 weeks. I have been on birth control pills since March that induces amenorrhea, so no heavy periods. All (upper and lower) GI and gyno u/s testing negative. Mammogram and bone scan and chest xray negative. No celiac disease and absorption is good. RA and Thyroid
work ups were negative.
Further bloodwork over the past 2 months have shown low alkaline phosphatase, low reticulocytes in addition. Other significant symptoms have been drenching night sweats, fatigue
, occasional low grade temps and chills, muscle weakness, stiffness and pain. I developed a heart murmur and tachycardia from the anemia and have occasional shortness of breath.
I just had bloodwork done last week. My hgb/hct/mvc are in normal range now but it showed high rdw, slightly above normal rbcs, neutrophil bands and basophilia. I am still symptomatic.
My hematologists' plan is to now take only 2 iron pills a day and re-check a cbc in two months.
My question is:
Is this the typical diagnostic approach for my case? If so, why? Is a bone marrow aspiration not indicated? Is this just an over response from the bone marrow because of the supplements or does this look like a possible MDS or CML? What do you recommend?