What does this mean?

[quanglewangle]

Hi.

Me = male, ET, 80 year old.

I am off to see the Haematologist on Tuesday so I asked the GP surgery for a copy of my latest Blood count - and I would appreciate any comments. All levels refer to 'normal' reference ranges

My White Blood Cell count, MCV, MCH, Neutrophil and Basophil are all above the upper limit (obviously platelets too) - and Haemoglobin, RBC, Haemocrit, are all below normal range.

What do you infer from this?

[quanglewangle]

P.S. I am on Hydroxycarbamide, Bisoprolol, Edoxaban, Omeprazole, a few other meds and a wide variety of Vits & Mins ....

[Mirror368]

I think you need to hav3 your hematologist explain your results. Good luck.

[hunter5582]

There is too little information here to do more than ask some questions. .

Some of the questions I would ask would relate to nutritional status, specifically iron and Vit B/folate, Given that you are taking Omeprazole, nutritional deficiencies are possible. Magnesium deficiencies are also associated with long term PPI use.

Low erythrocyte numbers (HGB, HCT, RBC), anemia, can occur for a number of reasons. Iron deficiency anemia is one of the reasons. There are also other forms of anemia, such as macrocytic anemia, which is caused by Vit B deficiency. There are also variants of MPNs that can result in low erythrocytes.

One thing to note is that hydroxycarbamide causes macrocytosis (MCV high). This is a known side effect and doctors sometimes use it to tell whether the patient is adhering to the use of the medication.

NEUT and BASO high could mean a number of different things, including your body's response to an infections. Some people with MPNs also run high on various leukocytes, more commonly with PV/MF than ET.

It is worth noting that there can be variations in CBC numbers for many different reasons. Single lab reads should not be taken out of context. It is the trend over time that matters.

There is no way for any of us to guess at what is going on with your CBC numbers. You will need to review your questions with a MPN Specialist. The doc may need to run some additional tests to determine what is going on. Suggest you create a written list of questions to take to the appointment and review with the hematologist.

Please do let us know what you learn and how you get on.

[quanglewangle]

Hello Hunter.

I can expand slightly in response to some of your points.

My CBC readings shown on the printout, cover tests taken throughout 2022 and 2023 - not just the latest - and all quoted variances have been slowly moving away from the ref ranges as indicated.

I supplement twice daily with (among others) Magnesium, B12 and Folic Acid but there are no values provided for any of these - or ferritin or iron.

Re nutritional status - this is clearly a problem as I am Coeliac and intolerant to quite a few foods; for two months I have been prescribed Nutrizyme 22 for suggested pancreatic insufficiency but that did not have any effect on the last CBC readings on 02/08/23 apart from some reduction in my way over ref range Urea level

I am awaiting a consult with Gastroenterology.

The good news is that blood glucose and cholesterol levels are all good so perhaps there is hope for me if I can persuade Gastro and Haemo to talk to each other.

Any pointers on appropriate questions to ask will be helpful

Cheers

[hunter5582 in reply to quanglewangle]

That makes things a bit more clear.

Collaboration between gastro and hemo docs is not optional. Your body is an integrated system and the GI issues and the MPN do interrelate. Holistic care is essential. You may choose to serve as the conduit for information sharing depending on the situation. We often benefit from serving as our own case managers.

The questions I would be asking the hematologist would be:

1. What is the significance in the progression in the numbers on CBC over time- declining erythrocytes, increasing leukocytes?

2. Could this indicate progression of the MPN?

3. Could nutritional deficiencies play a role?

4. What role does the overproduction of inflammatory cytokines play in exacerbating the Coeliac Disease? What impact does the inflammation from Coeliac have on how my MPN presents (e.g., reactive thrombocytosis)? Could the Coeliac Disease trigger neutrophilia or basophilia?

5. What testing do we need to do to explain what is going on? Next steps?

Note that your gastroenterologist likely knows little to nothing about MPNs and how they manifest. It is very common to need to educate other providers about MPNs. Good doctors will listen to the patient.

The questions I would be asking the hematologist would be:

1. What is the current status of the Coeliac Disease?

2. What impact is the Coeliac Disease having on my nutritional status?

3. What can I do to reduce GI inflammation that results from the Coeliac DIsease? What is the impact of systemic inflammation from the MPN on the Coeliac Disease?

4. Could the Coeliac Disease trigger neutrophilia or basophilia?

5. What testing do we need to do to explain what is going on? Next steps?

I think it is safe to assume that with having both a MPN and Coeliac Disease, inflammation is present in your body. I would be asking both docs about how best to manage systemic and GI inflammation in your situation. Since diet (e.g., Mediterranean Diet) and supplements (e.g., curcumin) are common interventions, you will want to have input on how to manage inflammation in the context of Coeliac Disease.

I would also let both docs know that you follow a holistic care model and that collaboration is essential. The question will be "How will you be collaborating on my care?", not "Will you."

Hope the next set of appointments yields answers. Please do let us know what you learn and how you get on.

[HazeBlue]

Macrocytosis

[ainslie]

Hard to say, it’s not unusual , if you posted the actual counts and ranges it might be useful.

MCV is often elevated on Hydroxy,

[russkatt]

It sounds like you are healthy to me, how do you feel?

[quanglewangle]

I FEEL FINE -

Thanks to - careful diet control (coeliac and multiple intolerances/allergies), my pacemaker (atrial fibrillation), various medications (joint pain, enlarged prostate, HU related conditions - pruritis, broken nails, actinic keratosis, erythromelalgia) covid mask-wearing and twice daily dog walks plus the aggravation of the fatigue, breathlessness, optical migraines, nosebleeds, etc ....

I FEEL GREAT and happy to wake up every morning