Suggest Treatment For Dizziness And Palpitations

Posted on Tue, 8 Nov 2016

Question: Hello,

I have had dizziness and feelings of rapid heartbeats almost most of the time and recently a bit of chest pains near the collar-bone areas. I took a blood test, my doctor didn't specify what condition I am in except that my blood cells are abnormal? Can anyone help interpret this? Do I have anemia? or more specifically, thalassemia? if so, how severe is it? below are my results:

Haemoglobin (low) 115 (119-160)
Red Cell Count (high) 5.9 (3.8-5.8)
MCV (low) 66 (80-100)
MCH (low) 19.6 (27-32)
MCHC (low) 299 (310-360)
RDW (high) 18.1 (10-15)
VITD (low) 32

*my iron results are normal, so I don't think that would be iron-deficiency anemia
*I do not know if my parents carry thalassemia traits, they don't know either

Answered by Dr. Ilir Sharka (45 minutes later)

Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that your symptoms are not related to your blood lab tests findings.

Regarding your blood lab tests findings, I would explain that anemia is determined by the levels of Hemoglobin. In your case it is slightly low, which means that you have a slight type of anemia. These levels of Hemoglobin do not justify your symptoms.

Your red blood cell count is really high and your MCV is low. These blood lab tests could be related to two conditions:

a- iron deficiency anemia, which has been excluded because your iron levels are normal.
b- thalassemia minor, which means that you are a carrier of one gene of thalassemia and you have inherited it from one of your parents.

I would recommend performing a Hemoglobin electrophoresis in order to exclude this possibility.

Anyway, there is nothing to worry about. Even if you have this disorder, you can live a normal and healthy life. The only problem is when having children. Because if your partner is a carrier too, your child will have 25% chances to develop thalassemia and amniocentesis should be performed.

Hope to have clarified your uncertainties!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (5 minutes later)

Hello,

I have read a bit about thalassemia, as I'm half asian so I think the possibility is quite high. My iron results are all normal, does that tick off iron deficiency anemia? Is it possible that I have thalassemia intermedia instead of minor? Because I do have symptoms of it and the MCV and MCH is pretty low?

Answered by Dr. Ilir Sharka (4 minutes later)

Brief Answer:
My answer as follows:

Detailed Answer:
Hello!

There is no thalassemia intermedia.

Thalassemia is determined by the presence of two parts (allele) of the same gene. If you have only one part (allele), it means that you are a carrier (thalassemia minor).

If you have both alleles, it means that you are affected by thalassemia major.

Such levels of MVC are quite normal in carriers (thalassemia minor).

So do not worry about it!

A hemoglobin electrophoresis would clarify everything.

Hope to have been helpful!

Best wishes,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (10 minutes later)

Thanks for explaining, if the chest pain were not caused by this, then why does it hurt? I have had chest scans and lung scans and they were all fine. However I had ECG and the person taking the test was unsure about the result. There were some abnormalties in the third line? So she gave it to my GP and she discussed it with another GP and they were all quite unsure. In the end they thought it shouldnt be a big problem and sent me home. I still do get those pains sometimes especially at night, it also affects my sleep

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Thank you for the additional information.

In such case, I would recommend performing further tests to investigate for the possible causes:

- an ambulatory 24-48 hours ECG monitoring would be necessary to examine your heart rhythm trends during a prolonged time
- inflammation tests for possible chostochondritis (inflammation) which could explain your symptoms.

I would also recommend trying an antiacid or omeprazole to exclude possible gastro-esophageal reflux or gastritis, which is known to be exacerbated during the night and could mimic all this symptomatology. If your symptoms are relieved by omeprazole, a fibrogastroscopy would be necessary to investigate for these disorders.

Hope to have clarified some of your uncertainties!

Wishing all the best,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (9 hours later)

My blood test also included C-reactive protein, which is normal <0.4 (0.0-5.0), as well as normal ANA. Does that exclude costochondritis? I called up my GP who did my ECG just now and she said she actually sent my ECG result to a cardiologist who said it was fine. If it's not costochondritis, and ECG is fine and it's nothing wrong with my lungs, what else could be the possible reasons? This has been annoying me for about 2 months now. Thanks.

Answered by Dr. Ilir Sharka (6 hours later)

Brief Answer:
My answer as follows:

Detailed Answer:
Hi again!

Thank you for the additional information!

Costochondritis can be excluded by the above mentioned tests.

Coming to this point, I would recommend considering two possible causes:

- anxiety
- gastro-esophageal reflux.

I would recommend performing thyroid hormone levels to exclude possible thyroid dysfunction too.

If the chest pain is relieved by an antiacid, it would indicate possible gastro-esophageal reflux or gastritis. In such case a fibrogastroscopy may be needed.

You should discuss with your doctor on the above issues!

Kind regards,

Dr. Iliri

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar