Border High RDW, Low MCV, High TIBC...what could it be?

[gotbaya]

Hi everyone,

Can someone help in understanding my blood test results?

Symptoms I suffer from are fatigue, chest tightness, loss of sensation in legs & arms, burning sensation in knees. forgetfulness, etc.

[jade_s]

Hiya, it's very difficult , impossible in fact, to read this image. Can you split it into multiple pics? You'll have to put each image in a separate reply, due to forum constraints.

What are you taking as meds/supps/injections?

[gotbaya in reply to jade_s]

Thanks for the reply jade_s I have added clearer images of the test results in the replies.

I'm not taking anything right now.

[jade_s in reply to gotbaya]

Thank you! That's much easier to read

Some strange things are going on, and please keep in mind I am not medically trained.

First things first, your B12 in far too low. This calls for an investigation into pernicious anemia (intrinsic factor (IF) antibodies, gastric parietal cells antibodies) and B12 injections without delay. This can explain all your symptoms. b12deficiency.info/signs-an...

Are you vegetarian/vegan?

The PAS website seems to be down so here is another link: b12deficiency.info/testing/ You don't need MMA and homocysteine because your B12 is already demonstrably low.

Keep in mind that the IF test can come back negative in up to half of people with PA. A positive result is diagnostic of PA, but a negative test does not rule it out.

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I don't see folate anywhere, that is also very important to test. Never start a folate supplement until you treat B12 first.

Vit D is also dire! Levels should be closer to 40-60 ng/mL. Your doctor should ideally recommend supplementation. You will probably need 5000 to 10,000 daily for several months to get levels up. Conventional wisdom now says to also take vit K2 to help absorption, and magnesium.

Thyroid looks ok for now. Next time I would ask for "Free T4" and "Free T3" rather than the "Totals", those are considered obsolete these days because they don't measure the usable free hormone.

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I'm having trouble interpreting iron / red blood cells. In your shoes I would urgently ask for a referral to hematology. They can check for other issues, for example thalassemia , which I know next to nothing about. It looks like there is more than just pernicious anemia / b12 deficiency going on here. Your previous labs (which were also difficult for us to read), showed the same trends.

High TIBC and low MCH point to iron deficiency, but serum iron and % saturation are perfectly fine (so do not supplement iron). Low MCV shows that your red blood cells are microcytic, i.e. smaller than they should be. In PA/B12D you would normally see high MCV. RDW is also trending high, so you've got a wide variation in the size of your RBCs, probably the PA/B12D and the other issue causing some to be large and some to be small.

I don't know if your red blood cells would normalize once you start on B12, but I suspect there is more to it than just B12 (in my nonmedical opinion), so please do push for more investigation, as well as prompt treatment of B12 deficiency.

Hope that helps. Please ask questions if anything is unclear.

[gotbaya]

CBC

Better clarity

[gotbaya]

TIBC

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[gotbaya]

Vitamin B12 & D

better clarity

[Cherylclaire Forum Support in reply to gotbaya]

Would be good to get FlipperTD to have a look if possible.

[FlipperTD in reply to Cherylclaire]

Here we go...

Without a longer timescale and test results over a few weeks or months it's difficult, but I'm never one to run away from something difficult. Remember, this is a scientist's thoughts, not a medic's.

Things I observed are borderline low MCV and MCH, RDW on the upper limit, raised TIBC, Iron at the upper end of the range and Saturation normal but at the lower end.

Here's some guesses. This looks to me like a partially treated, recovering case of Iron Deficiency. When iron deficiency hits us, the TIBC increases in absolute terms, and inevitably the % Saturation falls. This does NOT look like a Thalassaemia trait because the MCV and MCH would be lower than these results show. Iron deficiency in Thalassaemia would result in a lower MCV and MCH.

I'm not alarmed by any of these results but Vit D deficiency is really quite common, and a deficiency can give rise to all sorts of symptoms.

The B12 level is sub-normal and needs some thought. Tablets? Diet?

I hope this helps.

[Cherylclaire Forum Support]

FlipperTD is a scientist who has replied to my request for help interpreting your blood test results. In case you missed this response.