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Suggest Treatment For Iron Deficient And Pernicious Anemia

Posted on Sat, 26 Nov 2016

Question: In the last month I went through two Iron IV infusions and Vitamin B 12 shots after being diagnosed with Iron Deficient Anemia and Pernicious Anemia. For the last 4-5 years my WBC has been between 10-13 no matter what. RBC was 5.4 before testing and is 5.5 now. RDW is high and has increased to 18 but MCH and MCV are for the first time in years is "Normal" albeit both are the very lowest they could be without being Abnormal. MCHC is now on the cut off of high. hematocrit at 45 and Hemoglobin at 15 (finally!) Platelets are a little lower finally at 400 k/mcl. But where my WBC was always 10-13 for years it's now 7. Lymphocytes are lower than normal by a little bit and neutrophils slightly high. Reticulocyte count 170,000 and they tested for IgE which came back high. What would still be causing a high Reticulocyte count and what causes a decrease from what has been my predictable WBC- it's not considered low, but it's not my normal high side either. Finally What about IgE? Anything I should be concerned of with it? I also still have hematuria and hepatomegaly. I will be seeing a Neurologist in the coming week for progressively worsening bouts of disorientation that had been dismissed as vertigo, however my GP ruled out eustachian tube dysfunction (which had been her theory), and for trouble forming words and mashing up words. Anything I should ask about? I don't see my Hematologist for another few weeks, so I'm curious about the change in blood.

Answered by Dr. Hardik Sanghvi (4 hours later)

Brief Answer:
Don't worry about wbc and reticulocytes count.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

First of all your WBC count is 7000 and it is absolutely normal. It is different from your high normal count but there is nothing to worry about that.

Your reticulocytes count is definitely high. Reticulocytes are the premature form of RBC.
You have taken iron and vitamin B12 so your bone marrow start to produce more RBC and that is the reason for high reticulocytes count.

So high reticulocytes count after iron and vitamin B12 treatment is normal response and nothing to worry.

High IgE level suggest some allergy or hypersensitivity. So check your absolute eosinophil count and go for allergy test according to need.
Drugs like chlorpheneramine malate are useful. Steroids are the other option. But it is prescription based medicine.

You have hematuria and hepatomegaly. You should search the cause. You should go for ultrasound abdomen with liver and kidney function test. That will give you exact idea. Then you should take treatment accordingly.

For neurological problems you require complete neurological examination by neurologist. It is impossible to judge the neurological problems from online talk. Moreover it is out of my specialty. So consult your neurologist and plan accordingly.

Hope I have answered your all question.
If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic.
Wish you a very good health.

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

Follow up: Dr. Hardik Sanghvi (12 minutes later)

thanks! I actually had there high reticulocyte count prior to treatment and it didn't change after treatment, I guess I was thinking it would go down! I did get a message later today from my GP, after I initially wrote this message, that I tested positive for the MTHFR mutation C677T Homozygous or (T677T). does this factor into anything or is this a completely septate issue? thanks!

Answered by Dr. Hardik Sanghvi (20 hours later)

Brief Answer:
It is a separate issue.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

If you have high reticulocytes count before treatment also then you should go for peripheral smear examination. It can be seen in hemolysis or blood loss also.

MTHFR gene mutation is separate issue. That enzyme is needed to convert folate into folic acid and use of homocysteine. Its deficiency leads to high level of homocysteine and increase the risk of vascular disease like myocardial infarction and stroke. Active vitamins supplements are needed. It is not a serious condition but it is risk factor for cardiovascular disease. It has no relation with your reticulocytes count.

Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic.
Wish you a very good health.

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