What's the relevance of low mean cell haemoglob... - Thyroid UK

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What's the relevance of low mean cell haemoglobin, but normal haemoglobin concentrate levels?

TaraJR profile image
8 Replies

I'm confused about these results! Please can anyone help? What does mean cell haemoglobin mean? I I thought it meant I was anaemic, but my haemoglobin concentrate is normal. My ferritin is too low again I know.

I understand my thyroid levels. I'd reduced T3 from 30 to 25mcg for 6 weeks hoping my TSH would rise a bit to placate the gp, but it didn't! My normal dose is 100 T4 plus 30 T3.

Tests done according to the schedule we use, and 10 hours after last T3 dose.

As expected, my GP has marked everything 'normal, no further action'!

Total white blood count 5.3 10*9/L [4.0 - 10.0]

Red blood cell count 5.30 10*12/L [3.8 - 4.8]Above high reference limit

Haemoglobin concentration 138 g/L [120.0 - 150.0]

Haematocrit 0.421 [0.36 - 0.46]

Mean cell volume 79 fL [83.0 - 101.0]Below low reference limit

Mean cell haemoglobin level 26.1 pg [27.0 - 32.0]Below low reference limit

Platelet count - observation 243 10*9/L [150.0 - 410.0]

Neutrophil count 2.86 10*9/L [2.0 - 7.0]

Lymphocyte count 1.80 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.42 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.22 10*9/L [0.02 - 0.5]

Basophil count 0.01 10*9/L [0.0 - 0.1]

Nucleated red blood cell count 0.00 10*9/L [0.0 - 0.1]

Serum C reactive protein level 4 mg/L [0.0 - 10.0]

Serum ferritin level 40 ug/L [23.0 - 300.0]

Serum free triiodothyronine level 4.9 pmol/L [3.8 - 6.0]

Serum free T4 level 11.9 pmol/L [7.5 - 21.1]

Serum TSH level < 0.01 mu/L [0.35 - 4.94]

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TaraJR
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StitchFairy profile image
StitchFairy

Not sure, but this might help. Look under the heading Components of the FBC

labtestsonline.org.uk/tests...

humanbean profile image
humanbean

Red blood cell count 5.30 10*12/L [3.8 - 4.8]Above high reference limit

A high RBC count may indicate congenital heart disease, dehydration, obstructive lung disease, sleep apnoea or bone marrow over-production.

Mean cell volume 79 fL [83.0 - 101.0]Below low reference limit

This is a measurement of the average size of your RBCs. When the MCV is decreased, your RBCs are smaller than normal (microcytic), which may indicate iron deficiency anaemia, inflammation or occasionally thalassaemias.

Mean cell haemoglobin level 26.1 pg [27.0 - 32.0]Below low reference limit

This is a calculation of the amount of oxygen-carrying haemoglobin inside your RBCs.

...

What I think the above results are telling you is that you have a normal amount of haemoglobin which is spread over a higher number of red blood cells than usual which makes them paler than usual and therefore likely to be carrying less oxygen around. Your red blood cells, on average are smaller than they should be and each cell has, on average, a lower than usual amount of haemoglobin per cell.

...

Serum C reactive protein level 4 mg/L [0.0 - 10.0]

CRP is a measure of the inflammation you have. Optimal is less than 1. CRP can't be fixed directly, but it will be affected by having good levels of thyroid hormones and nutrients. If you have gut problems and are intolerant to gluten then being rigorous about eliminating gluten should help. Note that it isn't always obvious that people are intolerant to gluten, and the only way to find out is to give it up completely and find out if it improves health.

Serum ferritin level 40 ug/L [23.0 - 300.0] 6% of the way through the range

Your ferritin (iron stores) is really low, and is almost certainly the cause of your low MCV and MCH. Your doctor has ignored it because it's in range but optimal for anyone with a thyroid problem really needs ferritin to be mid-range or a little bit over.

A doctor ought to be convinced by the logic in the next paragraph that your ferritin shows iron deficiency, but in my experience it wouldn't happen :

If you had a ferritin result that had the standard female reference range (13 - 150) then a result which is 6% of the way through that range would be about 21. The NICE guidelines say that a level of ferritin of under 30 confirms a diagnosis of iron deficiency :

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

...

Ferritin levels are increased independently of iron status in acute and chronic inflammatory conditions, malignant disease and liver disease.

Expert opinion varies as to the level of ferritin which is diagnostic of iron deficiency anaemia in people with chronic inflammation — people with a ferritin concentration of 50 micrograms/L or higher could still be iron deficient.

The above comes from this link :

cks.nice.org.uk/topics/anae...

Please note that some doctors believe that women past menopause can't ever be iron deficient, which is clearly 100% nonsense. I don't know how old you are and this may be irrelevant to you.

Ideally you would have an iron panel done before supplementing iron. Medichecks do one, and it seems to be on special offer at time of writing :

medichecks.com/products/iro...

thyroiduk.org/help-and-supp...

For info on the iron supplements available in the UK :

healthunlocked.com/thyroidu...

...

Hopefully someone else will comment on your thyroid results.

Ex111 profile image
Ex111

Could be low iron .

radd profile image
radd

TaraJR,

Low MCHC should be looked at in relation to MCH. If both are low with hypothyroidism its pretty certain your RBC anomalies are due to iron deficiency.

Your body is using every means to carry on delivering oxygen but MCV & MCH are already under range meaning haemoglobin will eventually fall also.

Have you had an iron panel?

TaraJR profile image
TaraJR in reply to radd

Thank you. I'm still trying to get my head around these. I'd always just thought I should look at an overall haemoglobin level and ferritin.No, I haven't had any other tests done.

So do you think I should be taking iron?

I've been hypo since 1989 after I had RAI.

radd profile image
radd in reply to TaraJR

TaraJR,

Even though it's written in black & white the golden rule is not to supplement iron until you've had an iron panel indicating iron deficiency. The plus side is if you can get your GP to conduct an iron panel and prescribe supplements he will then have to arrange the follow up tests to ensure iron doesn't go too high.

Given that your ferritin is just 6.14% through range, MCV & MCH are below range I think you have every right to question your GP's 'normal, no further action'. Thyroid hormones are comparatively low but the sort of numbers I work best on; FT4 at 32.3 % & FT3 at 50% through range. Many members would prefer numbers higher in range.

TaraJR profile image
TaraJR in reply to radd

You're really helpful, thank you. I can get a Medichecks iron panel - iron, TIBC, transferrin saturation and ferritin. Are they enough? Not sure I can ask the GP to do them.

Yes my T4 is lower than I like it, and my T3 too. I'd dropped T3 from 30 to 25 for 6 weeks hoping my TSH might rise a bit to placate the GP, but it didn't shift. She's marked them as normal anyway, so I'll carry on getting my prescription and go back up to 30 T3.

I also had the coeliac test done. It was negative again as it was in 2015. I know I'm gluten sensitive/intolerant as my 6 week gluten challenge wasn't pleasant! It's proved it to me, if not to my GP.

radd profile image
radd in reply to TaraJR

TaraJR,

Serum iron, TIBC, transferrin saturation and ferritin would be in a usual iron panel. Unless there is tension between you & your GP, do ask for this test which is a usual run of the mill, as if deficient it puts the responsibility onto them to treat & monitor you.

The risk involved in changing stable thyroid meds to try altering a TSH to please a GP really isn't worth it as TSH can takes weeks/months/maybe never to catch up with any thyroid hormone level change.

There's a big difference between having coeliac autoimmune disease and being gluten intolerant. Symptoms similar to coeliac disease may be experienced but the antibodies are not produced and the gut lining damage is more limited. I think is more about the inflammatory response (I get immediate tinnitus If I eat gluten) that conventional medicine will never substantiate without raised IgA antibodies and mucosal damage.

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