What does Anaemic mean ?

[jodary]

I am a bit confused about what anaemic means. I have low folate at 3.82 ( the normal range is >3.89) , and red blood cells are 3.7 ( normal range 3.8 -5.8). Haemoglobin is 135 ( normal range 115-160) This is from blood tests done recently at my surgery. Yet at my last clinic visit my haematologist said I wasn't anaemic because my Haemoglobin was normal. I am currently on 500mg Hydroxycarbomide daily and platelets were stable in 600s but last time had started to increase again at 853. I have read that being anaemic can raise your platelet count so I am a bit confused now, as haematologist wants me to increase Hydroxycarbomide but is that making me anaemic or am I not anaemic. I would appreciate any thoughts before I see haematologist again.

[hunter5582]

Iron deficiency can cause reactive thrombocytosis. Anemia and Iron Deficiency are not the same thing. Anemia is a deficiency in HGB/RBCs. Iron Deficiency is having iron levels that are too low. While iron deficiency can cause anemia, it is only one of the types of anemia.

Diagnosing anemia requires evaluation of both hemoglobin and number/quality of RBCs. By definition, "Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues." mayoclinic.org/diseases-con....

It is expected that hydroxycarbamide (HU) would reduce the number of RBCs as well as PLTs and WBCs. HU works by interfering with DNA activity in hematopoietic stem cells, reducing all hematopoiesis, not just thrombopoiesis. It can be a balancing act to get the HU dose just right, reducing PLT without reducing the other types of blood cells too much.

It sounds like the doc is telling you that you do not meet criteria for anemia even though the total number of RBCs is slightly below reference range. Suggest you review all of the erythrocyte numbers and ask the doc for a more thorough explanation. it helps if you speak the same language when it comes to evaluating a CBC. You may find this presentation helpful in understanding what the numbers mean.

youtube.com/watch?v=Xj_yE1p...(Not working as expected?)

[jodary in reply to hunter5582]

Thanks for that , do you know where folate comes into it ? There seems to be quite a lot of symptoms associated with low folate levels.

[hunter5582 in reply to jodary]

"Folate (vitamin B-9) is important in red blood cell formation and for healthy cell growth and function." mayoclinic.org/drugs-supple....

Folate has other important functions in the body as well. Suggest a more comprehensive nutritional assessment if your folate is low (other B-vitamins, Vit D, Magnesium, etc.) your GP or hematologist can order these tests.

[Wyebird in reply to hunter5582]

loved that video thank you

[Wyebird]

hunter’s video says it all. In addition to confuse you further lol

I’m nearly always anaemic( low haemoglobin ) but very high ferritin which means that my body has all the ingredients but can’t increase my heMoglobin levels. Which means I can’t take iron tablets.

I really do hold haematologists in high esteem.

[ainslie]

I remember Clair Harrison saying there are different kinds of anaemia in MPN. eg me, I had Hgb at 150, rbc7.9, but MCV at 56 and ferritin at 8, this was the last year or so on venisection, I was far too low in iron/anaemia, haems tend to focus on MCV to assess iron deficiency.

Your numbers don’t look too bad currently, just under range on a few but maybe not significant?

Adding more Hydroxy will lower Hgb etc, is there some reason your Haem wants to increase the dose , platelets at that level are not often treated unless other risk factors or symptoms.

[jodary in reply to ainslie]

Hi, thanks for your reply. I have been on hydroxycarbomide since I was 63. I am now 66 ,platelets dropped from late 900s to 600s but are now rising again. Currently 853, that's why they want to increase it. I have been reading about symptoms of low folate and it sounds as if I would feel better if it wasn't that low, but they don't seem to be interested.

[ainslie in reply to jodary]

still not sure why you are treating platelets at that level? ie why not leave them at 853 on same dose, I dont know re folate, Haems are not generally interested in such fine tuning, I suppose you could add some to see what happens, ideally after telling haem

[jodary in reply to ainslie]

I've tried mentioning folate and have now asked if I can take a b complex to which they said yes. I have no intention of taking a higher dose at the moment but it seems to be an upward trend so not sure about if they get too high. I was just wondering about the connection between anaemia and increased platelets .

[hunter5582 in reply to jodary]

I have titrated the doses of the supplements i take based on pre-post testing to ensure I am taking the right amount. I worked with my Integrative Med doc to do this. I informed the rest of my care team about the supplement dosing so they would be aware. I prefer to base these decisions on measurable end points whenever possible.

[hunter5582 in reply to jodary]

Depending on you current dose of hydroxy, you may be able to tolerate a higher dose. As ainslie suggests, you would need to dose risk-benefit analysis of the higher dose, noting the adverse effects are dose-dependant. You also have the option to consider a different medication if you find hydroxy not to be suitable.