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I recently consulted my PCP for acute hair loss and fatigue.

Hi: I recently consulted...

Hi: I recently consulted my PCP for acute hair loss and fatigue. After running a TSH test (normal), she referred me to a dermatologist, who was much more thorough: she ran a CBC with (automated) Diff; a CMP; a testosterone level; B12; Vitamin D; ferritin; and TIBC. CMP, testosterone, B12 and ferritin were all normal. My WBCs were abnormal (3.6 on a scale of 4.0-12.4), as were my absolute neutrophils (1.8 on a scale of 2.2-8.6). My MCV was also abnormal (99 on a scale of 81-98). (The test results themselves used the term "abnormal" in red). My TIBC is also abnormal (241 on a scale of 265-497), and my Vitamin D is 13.4 on a scale of 30-100. My question is: should I seek referral to a hematologist?

Doctor's Assistant: When was the last time you had your levels checked? Have you noticed any weight loss or weight gain?

No change in weight, I don't think. Levels were last checked ... hold on, need to look.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

End of 2015. Only significant thing is celiac. Dx in 2010 and well controlled for past 8 years through strict GF diet.

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Answered in 10 minutes by:
3/26/2018
Richard Han
Richard Han, Board Certified MD
Category: Medical
Satisfied Customers: 968
Experience: Physican with over 15 years experience
Verified

Hello my name is***** am a board-certified physician with over 15 years of clinical experience and I am happy to help you. I've reviewed the above, but do you have a copy of the actual results printed out that you could attach to this chat thread? I'd like to see the numbers to all the results to better answer your question by seeing the lab values in context. If not, please let me know and I will proceed with an answer.

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Customer reply replied 29 days ago
I don't have a copy, but could copy and paste from the online results. Hold on.Component Results
Component Value Ref Range & Units Status
WBC 3.69 (L) 4.0 - 12.4 K/cmm Final
RBC 4.08 3.86 - 5.04 M/cmm Final
Hemoglobin 13.1 11.6 - 15.2 gm/dl Final
HCT 40.4 34.9 - 44.4 % Final
MCV 99 (H) 81 - 98 fl Final
MCH 32.1 26.7 - 33.3 pg Final
MCHC 32.4 32.1 - 35.9 gm/dl Final
RDW-CV 12.2 <14.7 % Final
RDW-SD 44.6 <50.4 fl Final
PLT 267 141 - 377 K/cmm Final
MPV 10.9 9.5 - 12.7 fl Final
Neutrophils 49.0 % Final
Lymphocytes 35.0 % Final
Monocytes 8.9 % Final
Eosinophils 5.4 % Final
Basophils 1.4 % Final
Immature Grans 0.3 % Final
ABS Neutrophils 1.81 (L) 2.20 - 8.85 K/cmm Final
ABS Lymphs 1.29 1.09 - 3.30 K/cmm Final
ABS Monocytes 0.33 0.1 - 0.8 K/cmm Final
ABS Eosinophils 0.20 0.03 - 0.61 K/cmm Final
ABS Basophils 0.05 0.01 - 0.11 K/cmm Final
ABS Immature Grans 0.01 0 - 0.06 K/cmm Final
Type of Diff: Automated Final

Thank you for inputting all the information! Give me a few moments and I will be back.

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Thank you for waiting. I've reviewed everything you've typed in. In my medical opinion, no, you do not need to see a hematologist. Your white blood cell count is minimally less than the lower limit of normal, and your differential values are fine. The MCV is basically normal, just above the upper limit of normal. Your TIBC being low is actually okay, because it is a measure of "empty seats" for iron, which being low means you don't really have any, which means you are NOT iron deficient, which is good, as is evidenced by you not having any anemia, i.e. your hemoglobin is good. Finally, and most significantly, your vitamin D level is VERY low meaning you are vitamin D deficient, which is very common for most Americans these days, due to limited dietary intake and decreased sun exposure. Vitamin D deficiency can definitely explain your presenting symptoms of fatigue and hair loss. In my opinion, all you currently need is to boost up your vitamin D levels and have them re-checked again somewhere down the line. Any other questions I can help with?

Richard Han
Richard Han, Board Certified MD
Category: Medical
Satisfied Customers: 968
Experience: Physican with over 15 years experience
Verified
Richard Han and 87 other Medical Specialists are ready to help you
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Customer reply replied 29 days ago
Okay, that's great news. Thank you!
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