Advice on blood test please

[Lincsangel1]

Hi everyone Just got these results back today

A few elevated levels..one below

Also elevated APTT 38.5 (26.9-34.5)

below range GFR 74 (90-200)

Any idea please ..feeling pretty rough x

[jade_s]

Sorry you're feeling bad Lincsangel1!

Have you had a full iron panel? Iron, % saturation, TIBC, ferritin.

Do you take iron? Red blood cells are ok but hemoglobin & hematocrit are high. I'm not an expert but this might indicate iron overload.

Sed rate is too low. Did they measure CRP to test for inflammation? Can be low for other reasons too.

Low GFR could point to kidney issues but can be caused by other things.

I 'm not overly familiar with "APTT" but a search shows it may mean your blood clotting time is too slow. Were platelets/thrombocytes, MPV, measured?

If i were you, i'd definitely push my doctor for further examinations. I don't think anything specific can be deduced from these results. But they warrant further action. Perhaps a referral to hematology?

I am not medically trained.

[jade_s in reply to jade_s]

Ah, i see you were on heavy antibiotics . That can mess up blood results too. Are you still taking them?

What exactly are your symptoms?

I would still ask for further workup, to check eg liver, kidney, and pancreas, iron as mentioned above, platelets, etc. Cipro can be a nasty antibiotic. I try to avoid it due to the black box warning of possible tendon rupture.

[FlipperTD]

Scientist, not medic.

I don't have enough information to try and figure out what's causing these changes, but I'll have a go nevertheless.

The ESR of 6 is absolutely fine. Absolutely!

The 'raised Hb and Haematocrit' are connected; if one goes up, so does the other. Everything else you've shown is within range.

First thought is 'could this be dehydration?' Episodes of vomiting or diarrhoea can easily cause this, or combined with reduced fluid intake could make you feel particularly grim, but this is just guesswork.

The raised APTT on its own is hard to comment upon.

eGFR is calculated, and whilst it's useful as a measure, there are numerous things that can upset it.

All of this is better discussed initially with your doctor, and then 'take it from there' but keep us informed!

Good luck.

[Lincsangel1 in reply to FlipperTD]

Hi Flipper TDThankyou for your reply

I did think about dehydration.. but I don't think it is.. I have been drinking plenty. I did have a day of diarrhoea about 2 week ago due to antibiotics but drank plenty of water and didn't feel dehydrated.

As I said to jade_s above ..I've done a bit of research and arrived at polycythemia.. I don't know if I'm way off the mark with this... it does seem to have some sort of relationship with B12 deficiency... and it states B12 deficiency can mask polycythemia..

Any further thoughts ?

[FlipperTD in reply to Lincsangel1]

Dear Lincsangel1

You're treading a difficult path here. Remember I'm a scientist, not a medic, but I know a lot about the terms and conditions. I understand your frustration!

Polycythaemia, simply, is an excess of red cells. But then it gets complicated. Why? Well, most cases are secondary Polycythaemia, which can be due to a load of other things.

Respiratory conditions which lead to lower oxygen levels will lead to raised Hb. This is due to the kidneys secreting more Erythropoietin [Epo], which drives the bone marrow to produce more red cells in an attempt to increase the oxygen levels.

As I've suggested earlier, dehydration will cause an increase in the Hb and Haematocrit. This is simply down to fluid balance. One thing for certain, an excess of iron would NOT cause this effect.

Living at high altitude [like VERY HIGH] will cause a secondary Polycythaemia too.

There are lots of other causes. Primary 'True Polycythaemia' or 'Polycythaemia Vera' is another matter entirely. It's a myeloproliferative disorder, and requires a haematologist for diagnosis and treatment. This is a rare condition, and it's far more likely yours is secondary to something else, rather than a primary disorder.

The 'B12 link' is assuming that in a case of True Polycythaemia, then although the bone marrow will produce excess red cells without any Epo, it still needs B12, folate and all the other stuff for making red cells. so, run out of B12 [due to PA or other reasons] then your marrow would struggle to maintain the Hb level. Of course, all the other PA issues such as neurological problems would continue.

Talk to your doctor, as they should understand, and if required, refer you to a haematology clinic . Good luck.

[Lincsangel1 in reply to FlipperTD]

Excellent advice.. as always from you... I love reading your replies on posts

You're right about me being frustrated.. I learnt a long time ago about the importance of doing my own research and not relying on Dr's for a diagnosis.. but this time I don't really know what to think

I just know that I don't feel great and need to do something about it.

I have an appointment with my gp September 1st... but need to go to it prepared, as everyone knows that face to face gp appointments are like hens teeth...

[FlipperTD in reply to Lincsangel1]

Good luck with this.

The question 'Could it be...' etc can be useful, as it shows you've done some research. Of course, bear in mind that the GP might just be reading this too.

Let us know!

[Lincsangel1 in reply to FlipperTD]

Thankyou...I will do !

[Lincsangel1]

Hi jade_sThanks for your reply

I finished the antibiotics over a week ago

My ferritin is 68.5.. I take a multi vitamin and mineral with 14mg of iron.. my ferritin was 17 last April. Full iron panel wasn't done this time.

Symptoms include extreme fatigue..headache.. numbness..pins and needles..burning.. pain.. dizziness and a few others

After a bit of research I came across polycythemia... blood results seem to fit as do symptoms

Last April my B12 was 122.. I have been self injecting first every other day..and now daily

I'm just so fed up at the moment... x

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[jade_s in reply to Lincsangel1]

I'm sorry you're feeling so bad. Without the tests, I would have said these symptoms are likely a flareup of B12D symptoms, due to the infection & antibiotics. Do you take any/enough folate or have a recent test?

In the early days (years), we are much more vulnerable to back-sliding due to infections and similar. I remember how miserable those early days were so please don't think i'm minimizing it. It took me a good 3-4 years before infections/colds didn't wipe me out and bring back raging B12D symptoms. xx How long have you been SI'ing now?

Polycythemia is outside my knowledge area. But from what I've read, i wouldn't immediately say this though, as RBCs are still in range. But I would push for further workup. There are plenty of additional tests they can do to rule this & other RBC diseases like thalassemia.

An iron panel when supplementing is important because ferritin on its own is not sufficiently informative. People can have high iron & low ferritin, and vice versa.

Flipper's comments are also reassuring

I know easier said than done, but try not to worry too much , push for additional tests, and keep SI'ing xx

[Lincsangel1 in reply to jade_s]

My first B12 blood test was April 2022.. when it was 122..I had been taking a combined supplement with B12 also for around a month before the test.I was given 2 lots of loading doses.. then started self injecting eod..then switched to daily, sometimes twice daily.

My folate on the last few bloods has been over 20.. this test its 17.. there is folic acid in my multi vitamin

Altho the brain fog is less now.. none of my other symptoms have really improved

In fact the fatigue is gradually getting worse..

I had bloods done on the 8th and again on the 22nd..so only 2 weeks apart..

Haemaglobin rose by 9.. haematocrit rose also

The reason for these bloods was to look for inflammation as I have had problems with my right hand for a while..had steroid injection months ago..but no improvement..and now pain in left hand...also arms legs and neck x