Help Me Understand Blood Test

Hey,

I've known I had thalassemia for a while now but never thought about it too much.

RBC - 6.94
HGB - 15.2
HCT - 49
MCV - 70.6
MCH - 21.9
MCHC - 31.0
RDW 16.4
Ferritin - 491
Iron % Sat - 49

I have a few questions.

1) Based on these results, would you say I should experience any symptoms? I play table tennis and I seem to tire out a bit more easily than my peers.

2) Would you consider this a bad Ferritin level? My levels have been this way for the past couple of years, so not due to inflammation, and I've had symptoms of high ferritin, such as low libido.

1) Even with your high Hb, you may have some symptoms that are not related to Hb, but instead are related to the overproduction of red blood cells. Your RBCis quite high, which does show that your normal Hb is accomplished by overproduction of red blood cells. The unmatched globin chains caused by alpha and beta globin not being evenly produced, and along with the by products of the destruction of defective red blood cells can cause many issues in thalassemics. In fact, the main goal of transfusion in majors is not necessarily raising the Hb. The goal, which can only be accomplished by raising the Hb is to slow down the ineffective electrophoresis that takes place in the bone marrow and produces so many defective red cells. This also takes place in minors, so even though you have a good Hb level, it takes a high RBC to make that happen.
Many of the nutritional recommendations I give are intended to help the body produce better quality red cells, that aren't removed by the body so quickly.

2) The ferritin is high, but unless you have a history of long term iron supplementation, it should have no real relevance.

Has your bilirubin level been tested? I would assume it is high, due to red blood cell destruction, which produces bilirubin.

Hi Andy,

Could you review my most recent CBC, as my doctors haven't explained what it means?

MCHC.            28.7L      31.5-35.7 g/dL
PLT count.       279        150-379 10^3/uL
RDW.              14.8       12.3-15.4%
Hemoglobin.    13.3       11.1-15.9 g/dL
MCH.              21.6L      26.6-33.0 pg
RBC count.      6.15H     3.77-5.28 10^6/uL
Hematocrit.     46.4       34.0-46.6%
MCV.               75L        80-100fL
WBC count.      5.3        3.4-10.8 10^3/uL

Thanks!
Giovanni

Hi Giovanni,

Your MCV is low and your RBC is high, which both show that thal minor is probably present. I am sure this has been confirmed by hemoglobin electrophoresis. The RDW is normal, which is good and means you do not have iron deficiency. Your Hb level is also normal, which is also good for thal minor.

From your bio, I see that you are beginning to see health issues, in spite of the normal Hb level. This is because thalassemia is more than a lack of hemoglobin. Because the bone marrow is overactive in thal minors, many defective red blood cells, RBCS are produced, which are then destroyed by the body. In addition, in beta minor, there is a deficit of beta globin, so there is not enough beta globin to match the alpha globin that is produced, resulting in excess alpha chains that form tetramers that cause oxidation in the body. Both the bits of defective red blood cells and alpha tetramers are debris that cause problems in the bloodstream and we see poor circulation to the extremities as a noticeable result of this. This will be seen in numbness and cold in the extremities. I believe it also has something to do with the mind not being as sharp as it should be sometimes, and this is caused by poor circulation, which means less oxygen to the brain and other organs.

Thalassemia also causes depletion of many nutrients. My focus for thal minors is always based in understanding the nutritional needs of minors and addressing those needs. The section of this website on nutrition in thal minors can be very useful. From your bio, I would immediately suggest once weekly large doses of vitamin D, unless you get regular daily sunshine (I take 50,000 IU once weekly), 400 IU natural vitamin E daily (I recommend to all thals) and at least 500 mg of vitamin C daily (very important for blood vessel health). Vitamin B-12 and L-methylfolate can be very helpful in fighting fatigue. I don't carry thal, but as I get older, I find my thyroid fatigue wears me out unless I take both B-12 and Folate daily.

Look over the section on nutrition and make sure your diet is a source of nutrition and not empty calories. As you get older, you'll do much better if you start paying more attention to nutrition now.