Pernicious Anaemia Society
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Abnormal shaped red blood cells

Hi. I have been getting B12 shots and iron infusion every other week since end of April following major Blood transfusion when hospitalized and diagnosed with hemoglobin of 4.5. They told me that the red blood cells were getting better and not as misshapen and getting more uniform in size so I figured everything was going along just fine. Now I am still being told that new red blood cells I'm making aren't normal in shape and size yet so may need further blood transfusions in future if I don't start producing normal oxygen carrying cells. How long does it take for new cells to return to normal? I am starting to get scared. Has anyone else's cells been abnormal in shape and size and is this a normal part of the body's attempt to start making red blood cells once treatment starts? I was too astounded and had to let this sink in before I was able to ask my oncologist-hematologist. I'll see him again for next treatment and more blood work the end of next week.

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Hi CH52 do you know what your Folate level is?

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.

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do you know what is wrong with the red blood cells - too small or too large?

too small would point to iron being the problem.

too large would be perplexing as this should correct with the B12 shots unless you have become iron deficient ... or you have a reaction which means that you are functionally deficient - at the cell level.

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If you have time for some reading, Ed Uthman's pages are very informative. This one is about the standard CBC tests:

The paragraph that I thought you might be interested in is this one that talks about how long it takes for new cells to form and how long those cells last:


Structurally the simplest cell in the body, volumes have been written about the lowly red blood cell. The basic function of the rbc is the creation and maintenance of an environment salutary to the physical integrity and functionality of hemoglobin. In the normal state, erythrocytes are produced only in the skeleton (in adults only in the axial skeleton), but in pathologic states (especially myelofibrosis, which will be covered subsequently) almost any organ can become the site of erythropoiesis. Numerous substances are necessary for creation of erythrocytes, including metals (iron, cobalt, manganese), vitamins (B12, B6, C, E, folate, riboflavin, pantothenic acid, thiamin), and amino acids. Regulatory substances necessary for normal erythropoiesis include erythropoietin, thyroid hormones, and androgens. Erythrocytes progress from blast precursors in the marrow over a period of five days. Then they are released into the blood as reticulocytes, distinguishable from regular erythrocytes only with special supravital stains. The reticulocyte changes to an erythrocyte in one day and circulates for 120 days before being destroyed in the reticuloendothelial system."

So, basically, it takes nearly a week to produce new, healthy cells, and they circulate in the body for around 4 months.


Thanks to all of you who replied. I do not know my folate levels but will find out next week as my doctor said he needed to check folate again so more tests were run over a week ago. This also explains why he said I would be ok for a few more months before I would need Additional blood transfusions if hemoglobin goes to 7 or below. (I'm in the US). My hemoglobin dropped down to 10 over the last month while getting my loading iron infusion and B12 shots every 2 weeks . My cells that are forming are smaller than they should be. This was an issue from the start of blood work following transfusions they were starting to get larger and shaped more normal but then never completely hit normal. When in hospital they tested thyroid and that was normal. I did test positive for PA. They have just dropped my iron infusions to once a month instead of every 2 weeks as the iron was showing good levels. At least now I will be able to question oncologist next week about his rational on treatment plan & get copies of my recent blood work so I can understand my blood work levels better. Again thanks. I've been very stressed out over this the past few days.

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