Need help with lab results. PCP didn't even mention results!

[Cebner]

Good Morning everyone!

I'm new here and need a little bit of help and advice. I just received my lab results and spent over 8 hours researching online what they seem indicate, but I have 0 experience with anemia of any sort and I'm hoping someone can take a look at my results and tell me what they think?!

Quick background on me: 34 year old female with healthy height/weight ratio. I've been struggling with short term memory problems, word finding difficulty, concentration deficits for at least 10 months; tremor, eye twitch, migraines, and fatigue for about 2 years. Rapid heart rate (92-105 beats per minute on average) and palpitations for the past 2-3 months. Those are the most prominent symptoms although I have quite a few others.

My PCP didn't mention anything being out of range, yet the results say high MCH and MCV and low RBC and RDW.

I am going to try and attach pictures of my lab results which include CBC, Ferritin, thyroid panel, CMB and hope you guys can help guide me some, please!

[Cebner]

I cant seem to upload the photos of the remaining labs but they are:

TSH: 1.0 (.350-5.50)

Free T3: 2.3 (1.71-3.71)

Thyroglobulin antibody: 1.5 (<5)

Thyroid peroxidase antibody <3 (<6)

Ferritin: 53 (range 11-209)

Firon: 97 (25-156)

Firon binding capacity: 341 (240-450)

Firon saturation 28 (23-59%)

[fbirder]

You have red blood cells that are larger than normal (high Mean Cell Volume). Because they are large they have more than the normal amount of haemaglobin in each cell (high Mean Cell Haemaglobin) and there aren't as many of them as usual (low Red Blood cell Count). The low Red cell Distribution Width means that all of your red cells are about the same size.

These are all signs of macrocytic (large cell) anaemia.

The most common causes of macrocytic anaemia are deficiencies in vitamin B12 and/or folate (Vitamin B9). Did you have either of those measured?

Your symptoms do sound a lot like those you get with a B12 deficiency. You need to have your serum B12 tested. While they're at it they should also test MMA, folate, and Intrinsic Factor antibodies (to see if the cause is Pernicious Anaemia).

They should also start you on a course of B12 injections to see if that gets your blood back to normal and reduces your symptoms.

Good Luck

[Cebner in reply to fbirder]

Thank you so much for your reply! I haven't had my B12, MMA or folate tested. My doctor didn't even mention these labs being out of range, even though I was being tested to check for anemia, by her suggestion! She said 'everything looks good and is normal'. I believe she was looking for iron deficiency as a result of my period coming every 14 days for 12 weeks, and she overlooked the labs that were out of range since my iron levels were normal.

Does it make a difference that my rbc and rdw are minimally low and mcv and mhv are minimally high as opposed to a more moderate out of range value? I guess what I'm trying to say is: am I going to have to fight with my doctor to get treatment for this since my results are marginally out of range or is this clearly macrocytic anemia? Is this questionable and something that she can just brush off bc of my values?

Ugh, I'm sorry I'm just a little frustrated with this whole situation!

[fbirder in reply to Cebner]

Yes, those results are only just out of range. But they do indicate that your red cells are larger than normal. Combined with the symptoms I would conclude that B12 deficiency is a distinct possibility.

[Cebner]

I took the advice you guys offered and requested additional labs from my PCP. I asked for a B12 which was 350 (range 213-816pg), MMA which was 175nmol (87-318nmol) and a folate which was 14.3 (>6.9).

I thought the B12 was low but then the MMA came in and seems within range. So I'm a little confused. Of course my doctor is of no use as usual...

Any insight?