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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13481
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I was recently diagnosed with Anemia This is my first cbc

Resolved Question:

I was recently diagnosed with Anemia
This is my first cbc w/diff
WBC 3.5 - 10.6 K/uL 4.2
RBC 3.80 - 5.12 M/uL 2.97 L
Hemoglobin 11.9 - 15.1 g/dL 5.1 LL
Hematocrit 34.9 - 44.1 % 18.6 L
Mean Cell Volume (MCV) 80.2 - 97.6 fL 62.7 A
Mean Cell Hemoglobin (MCH) 27.0 - 33.6 pg 17.1 L
Mean Cell Hemoglobin Concentration (MCHC) 33.0 - 35.2 g/dL 27.2 A
RDW 11.2 - 16.5 % 23.2 H
RDW SD 50.8
Platelet Count, POC 150 - 386 K/uL 196
Mean Platelet Volume (MPV) 7.0 - 10.6 fL 9.2
Neutrophils Percent 45.9 - 73.8 % 35.6 L
Lymphocytes Percent 15.1 - 41.8 % 55.3 H
Monocytes Percent 4.7 - 12.2 % 6.1
Eosinophils Percent 0.0 - 5.4 % 1.9
Basophils Percent 0.0 - 1.8 % 1.1
Neutrophils Absolute 1.8 - 6.7 K/uL 1.5 L
Lymphs Abs 0.9 - 3.0 K/uL 2.3
Monocytes Absolute 0.0 - 1.0 K/uL 0.3
Eosinophils Absolute 0.0 - 0.5 K/uL 0.1
Basophils Absolute 0.0 - 0.1 K/uL 0.0
Anisocytosis 1+
Microcytes 1+
Macrocytes 1+
Hypochromia 2+
Tear Drop Cells Few


I then had three units of blood two weeks of iron pills, that I could not stomach and started iron infusion supposed to have 12 at three each week just finished my 6th and this cbc w/ diff was taken on Wed.
WBC 3.5 - 10.6 K/uL 5.8
RBC 3.80 - 5.12 M/uL 4.44
Hemoglobin 11.9 - 15.1 g/dL 12.3
Hematocrit 34.9 - 44.1 % 38.5
Mean Cell Volume (MCV) 80.2 - 97.6 fL 86.8
Mean Cell Hemoglobin (MCH) 27.0 - 33.6 pg 27.7
Mean Cell Hemoglobin Concentration (MCHC) 33.0 - 35.2 g/dL 31.9
RDW 11.2 - 16.5 % 32.8 H
RDW SD 94.9
Platelet Count, POC 150 - 386 K/uL 267
Mean Platelet Volume (MPV) 7.0 - 10.6 fL 8.6
Neutrophils Percent 45.9 - 73.8 % 62.9
Lymphocytes Percent 15.1 - 41.8 % 26.7
Monocytes Percent 4.7 - 12.2 % 7.9
Eosinophils Percent 0.0 - 5.4 % 2.2
Basophils Percent 0.0 - 1.8 % 0.3
Neutrophils Absolute 1.8 - 6.7 K/uL 3.7
Lymphs Abs 0.9 - 3.0 K/uL 1.6
Monocytes Absolute 0.0 - 1.0 K/uL 0.5
Eosinophils Absolute 0.0 - 0.5 K/uL 0.1
Basophils Absolute 0.0 - 0.1 K/uL 0.0
Anisocytosis 3+
Microcytes 2+
Macrocytes 1+
Poikilocytes 1+
Hypochromia 1+
Ovalocytes Few
Tear Drop Cells Few

Inbetween the two cbc's we found out I have an enlarged spleen. All this with in four weeks any ideas on cause?
Submitted: 12 months ago.
Category: Medical
Expert:  Dr. D. Love replied 12 months ago.
Thank you for using JustAnswer. I will be glad to assist you today.

The primary cause of anemia of this initial severity (hemoglobin of 5.1) with an MCV of 62.7 is iron deficiency. Strictly speaking, it would require iron studies to make a definitive diagnosis, but this is vastly most likely the cause.

The other common cause of an anemia with a low MCV will typically not cause an anemia of this severity. This other anemia is called anemia of chronic disease, and is due to poor iron utilization, so will look like iron deficiency, even though there is plenty of iron in the body.

It is also possible that there could be a mixed anemia in which there are other contributing factors, but the vast majority will have simple iron deficiency.

In menstruating women, iron deficiency is primarily related to chronic blood loss from the monthly menstrual cycles, although exacerbated when there is poor oral iron intake. In non-menstruating women and adult men, iron deficiency is a concern that there may be another problem causing blood loss, so there will typically be an evaluation to find the source of blood loss, but there is no mystery in menstruating women.

An enlarged spleen is non-specific, in that it can occur in many different types of anemia, including iron deficiency anemia.

Although a blood transfusion is appropriate when there is such an initial severity of anemia, the long-term treatment is by iron supplementation. We prefer to perform iron supplementation with pills, but if the pills are not well tolerated, then injections of iron are appropriate.

If you have any further questions, please let me know.

Customer: replied 12 months ago.

I am scheduled for an ablation in Dec. what my doctors say is they "hope" this takes care of it. Could there be any other possibilties? My periods are not normally heavy either. We also know I have a low b12, but my doctors keep saying that they don't feel the enlarged spleen has anything to do with the anemia. I am not scheduled for ct until mid November.

Expert:  Dr. D. Love replied 12 months ago.
The information that you have provided does not explain how your doctors have made these comments. If your uterine biopsy was normal and your periods are not heavy, then it is unclear what your doctors are hoping will be taken care of. It is also unclear how the doctor can say that the enlarged spleen is not related to the anemia when it is a common finding in iron deficiency anemia. It is possible that your doctor has some information that is unknown to you so that you cannot relay it here, but with the information that you are able to provide, these statements do not make sense.

As I noted above, there is always a possibility that there could be another factor involved in combination with the iron deficiency to cause the anemia, but there is no other possible cause of such a severe initial anemia with a low MCV.

There are also many other possible causes of an enlarged spleen, including other causes of anemia (such as hemolytic anemia), various infections (including viral, bacterial and parasitic infections), liver disease, and certain cancers. But if there is a known cause of an enlarged spleen (the iron deficiency anemia), then it would be appropriate to correct the iron deficiency anemia and then assess whether there is a persistently enlarged spleen.

As independent verification that iron deficiency anemia can cause an enlarged spleen, please review http://www.hopkinsmedicine.org/healthlibrary/conditions/hematology_and_blood_disorders/iron-deficiency_anemia_85,P00077/. The reference to an enlarged spleen is located about one-third down the page.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13481
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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