Update 8.3.1

[hunter5582]

I did the CBC at mt hematology office today as planned. Recall this from my last post..

My most recent CBC at the PCP 09/06/24 shows HCT=46.2 HGB=14.7. The CBC at my local hematologist on 08/02/24 showed HCT=42.7 HGB=14.2. It seems a rather large jump in a short period of time given that the HCT has been stable in recent months. I am thinking this may be an anomaly, which has happened in the past. I am scheduled for a CBC at my local hematologist on 09/27/24. I am planning planning to defer doing anything until the HCT/HGB numbers are confirmed. If confirmed, will schedule a phlebotomy.

As of today 09/27/24 HCT=44.2 HGB=14.5. As I expected, I do not need to consider a phlebotomy at this point in time. The higher read at 46.2 appears to have been an anomaly. Perhaps the time of day for the higher read, 8:30am, and the fact that is was a fasting blood test, possible lower hydration, played a role. We will likely never know for sure, but it is all good.

My next CBC will be 12/02/24. We are planning a repeat of the JAK2 quantitative analysis at that time.

Until the next time, wishing all of you all the best.

[Lyndjs]

Thank you for sharing hunter5582 , good to know you didn't need the phlebotomy.

In a previous post, I'd noticed you'd commented on levels for bloods taken at a different time of day can differ, and I have also seen this in my own results too. I agree hydration may well play a significant part as, blood taken early morning had higher levels than other test taken late afternoon. Following your comments/ observations,I now stick to late afternoon blood tests.

I hope all goes well for you and I shall look forward to hearing your JAK 2 news.

Thank you for helping us all to understand our MPNs and your ongoing support xx

[Mostew]

Good news ... Just proves no use imagining 'the worse' till it happens . When we can deal with facts not fantasy

Hope you have a peaceful

weekend everyone

[RoundTheWorld]

Good news! Glad you don’t need phlebotomy and can forget about tests for a while.

[gjh8733]

I had a similar experience recently Hunter. In a 2 day period my Hct went from 45.9 (Sep 16) to 41.3 ( Sep 18). Blood was taken at the same time of day and post lunch I.e. 2.00pm

Two factors I believed contributed to the difference. On the 16th I had a pretty strenuous 1 hour work out in the early morning with heart rate near max for 20 plus minutes. I think this level of aerobic exercise could resulted in splenic release of stored RBCs as happens with exercise which would drive up HCT in contrast on the 18th I had a very relaxed day with no exercise at all

Second factor was difference in hydration levels - using the total protein levels measured on the 16 and 18 vs Hct indicated that 1.5% could be explained by hydration.

Lesson learned going forward is no strenuous exercise on the day of a blood sampling or scheduled phlebotomy and drink plenty of water!

[LIGEBA in reply to gjh8733]

Can I ask how protein levels correlate to hydration? I had no idea?

[gjh8733 in reply to LIGEBA]

Hi LIGEBA

Sorry about the delay but I have been traveling.

So as explained to me, it goes as follows:

Total Protein (TP) consists primarily if the non cellular proteinaceous components of blood - albumen and globulin - while HCT - consisting primarily of RBCs - is the principal cellular component.

TP level in plasma is dependent upon hydration level - it is only impacted by significant protein production/loss associated with liver/kidney disease states. Thus if hydration levels are similar between days and RBC count is similar, the ratios should be consistent (assuming no significant liver/kidney disease)

To compare hydration levels, one can use Day 1 HCT/TP vs Day 2 HCT/TP. If hydration is similar between days, then the equation balances out and any difference is driven by HCT. in my case the numbers were Day 1 : 45.9/7.2 and Day 2: 41.4/6.8

To compare hydration levels, if we let x = Day 2 HCT, and solve for x, then X = 43.35. This would be the expected HCT if the hydration levels on day 1 and 2 were identical.

However my day 2 HCT was 41.4 so a 2% difference.

So the 4.5% elevation in my dAY 1 HCT over day 2 could be explained by a 2% in hydration levels. The remaining 2.5% increase in HCT I am putting down to the intense workout on that morning, given that in PCV there is sequestration of RBC in the spleen

Let me know your thoughts on the above and if you see any gaps in logic.

[Hopetohelp]

Good news. Well done. I am sure a blood test early in the day will affect blood results if test normally carried out later in day. Always try to get mine done around midday having drunk gallons of water😅

[Hidden]

good news and glad you don’t need the phlebotomy. Keep on trucking and thanks for all your always great input and reasoning(s) on this forum. Very best health to you.

[lizzziep]

Good you don’t need the phlebotomy. I always find your posts so informative, hope all goes well for you.

[Gaithersburg]

Thanks Hunter as ever for keeping us updated and please that it was just an abnormality.

[Bikecrazy]

Happy to see no major change.

[KLCTJC]

yeah!!! Glad it is going well!

[saltmarsh]

Congrats Hunter. Good news for sure

[Hidden]

So happy for you Hunter

[Jamesxyz]

As I recall you had a tp recently. So it appears that you're HCT is on the increase.

Perhaps the IFN is loosing effectiveness.

Varaitaion of 2% can occur just from water consumption.

Curious to see teh RBC numbers as well.

No fun needing a tp every couple of months.

[Manaaki]

Thanks for sharing your update and your decision making process! I am really happy to hear that it was an anomality and you don’t require a phlebotomy! Reading your posts always brings such a peace with it as you are methodical and calm in your approach. Wishing you all the best going forward!

[hunter5582]

I have been averaging a phlebotomy about 1x/year since starting in the IFNs. I am maxed out on my Besremi dose at 175mcg. If the pace of phlebotomies seems to be picking up, we will assess and consider options. It may also be that over time my iron levels are steadily increasing. The doc just ordered an iron panel so we will see how that looks next week.

All of my other erythrocyte numbers look good. RDC-CV is the only one that is a bit high at 16.6. RDW is always around this range. RBC=5.5, MCV=80.4, MCH=26.4, MCHC=32.8. On the whole, good numbers that are in reference range.

Other numbers look good too. PLT and all WBCs except LYMPH (low at 0.58) are within reference range. Overall good news.

All the best.

[LIGEBA in reply to hunter5582]

Hunter, just curious, are you experiencing any increased symptoms along with the increased HCT?

[hunter5582 in reply to LIGEBA]

No increased symptoms at all. The HCT is still too low to expect any.

[beetle]

it’s always great to hear good news. I had a blood test that told me I had a Hgb of 132 a few weeks ago. I was certain this must be a rogue result and as I suspected a couple of days later it was under 100!

I am in hospital again while they try and figure out severe pain in my left hip, humerus, knee and weirdly half way down my tibia where it stops abruptly but feels like someone is sticking a knife in there. I am due a CT scan tomorrow but as bone pain is a fact of life for some with MF and or MDS and can also be caused by Azacitidine I am taking a guess that that is what is happening. They are trying to work out suitable pain relief. Oramorph is the chosen poison at the moment but I am also getting some relief using a TENS machine.

Take care. Very best wishes, Jan

[hunter5582 in reply to beetle]

Sorry to hear about the ongoing bone and joint pain. This is an unfortunate symptom for some with MPNs. Perhaps a contributing issue (not the MF) can be identified that is playing a role. It would be better to treat the cause rather than the symptom. Hopefully. the testing will provide some options to reduce the cause of the pain.

Wishing you success moving forward.