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Am I, as a 55-year-old female, anemic? If so, which tests…

Am I, as a 55-year-old...
Am I, as a 55-year-old female, anemic? If so, which tests should I ask for next? HCT: 37.5%. HGB: 12.5 g/dL. RBC, Auto: ***** ***** WBC's auto: ***** ***** 1000/mcL. MCHC: 33.3 g/dL. (There are more, but these are the lowest levels.) I've been experiencing the following neurological symptoms for 2 1/2 years (sudden and distinct onset during a supposed stomach virus or something). (A vitamin D deficiency (level 26) was found 1.6 years ago which might cause the continuing neurological symptoms, since vitamin D deficiencies can take a while for the bones to er, remineralize[?] and tissues to respond.) But it's lasted too long, and in addition to shaking hands, I'm still having forehead numbness that can spread to cheeks and mouth, flashing lights or distinct patterns, occas. rhythmic flashing, slack and numb ankles, lack of coord. in fingers, hands, arms, and legs, heavy dragging slack legs, unusual fatigue, distinct tinnitus, ear fullness, occas. ear numbness, less balance w/swaying, twitching muscles (eye and other muscles), pressure in toe, vibrations in legs and torso (and some in head or front of face that are milder), pale nails, dizziness, and stomach pain. Lost lots of muscle. These are all mentioned because they might jive with B12 deficiencies which can cause anemia(?). And I ascribed them all to a vitamin d deficiency that has since gradually come into normal range (48). B12 serum is normal at 686 pg/mL. MMA test: 0.19 umol/L (standard range <=0.30 umol/L). Thank you for any insights!
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Answered in 11 minutes by:
3/16/2018
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,443
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hello from JustAnswer. This is Dr. Love.

No. You are not anemic. The values are low in the normal range, but they are still normal, so would not be considered anemic. There is no further evaluation that needs to be done for the blood count values.

You are correct that neurologic symptoms can be related to vitamin B12 deficiency, even if there is no anemia, but since your vitamin B12 level is 686 pg/ml and your MMA is 0.19 umol/l, then you are clearly not vitamin B12 deficient.

What neurologic evaluation has been done thus far?

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Customer reply replied 1 month ago
Saw a neurologist 2 years ago and he didn't have a clear reason for the cause - theorized possible exposure of some type (since my husband's digestion and head were also affected for several months, when these things began for me). Had an MRI test of body and head - found one small lesion at top center but was not inside the, er, brain area. He said if I wanted to come back in one year for a CT scan to make sure this small lesion didn't change. Since I've felt so strange and er, real bad, I haven't wanted to expose myself to whatever admittedly minute radiation the CT scan would have. At that time, two years ago, he was not concerned about it. There was also a bone scan (with nuclear material put into veins) - came out fine. (Many other tests outside of neurology area.) Two years ago reflexes were fine. (I experience a strange brief lag time now when reading. Among the above mentioned.) Thank you for your response!

If it has been two years since you have seen a Neurologist, the next step that I would recommend is to see the Neurologist again. Seeing the same Neurologist would would have the advantage that they are already familiar with what was seen on neurologic exam previously, but seeing a different Neurologist would have the advantage of providing a second opinion. There are certain neurologic problems that can take multiple evaluations over a significant period of time to elucidate what is happening. For example, certain inflammatory conditions of the brain, such as multiple sclerosis, is not diagnosed when first seen, but the diagnosis becomes clear over time.

It also would be reasonable to repeat the imaging test. A repeat MRI would usually be considered, but there may have been a particular characteristic of the lesion that prompted the Neurologist to recommend a CT scan. An MRI would also avoid the radiation exposure that is included in the CT scan.

Depending upon what is found on neurologic exam, then other tests can also be considered. But since your symptoms are broad and affecting multiiple components of the nervous system, conditions that can affect multiple sites of the nervous system would be reasonable to consider first, including the inflammatory conditions noted above. The MRI is the most sensitive imaging study to look for evidence of inflammatory conditions. Specific nerve tests, such as evoked potentials, or a lumbar puncture can also be considered

If I can provide any additional information, please let me know.

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
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Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer reply replied 1 month ago
Thank you very much for your generous and thorough information! (Will schedule an appointment with a different neurologist.) This helped greatly. Goodbye for now, and my best regards!
Customer reply replied 1 month ago
This helped me see what's commonly on the horizon and familiarized me with some ideas and possibilities.)
Customer reply replied 1 month ago
39;Bye again! Thank you.

You are very welcome.

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