blood test results

Hello everyone,

I am new to this site.  This is a wonderful site where loads of information and advice are available.  I would have been quite lost without the information.

I am 30 years old and a mother of two children, a girl of 5 yrs and a boy of 4 yrs.  My sister in law was recently diagnosed with thal (carrier) and I have been carrying blood tests for my children, my husband and myself.  My husband's results are all within the reference range.  My blood test results are not that good and those of my children are not that superb though their results have been improving over time.  In the island where I live, there are no haematologists.  Thus I have brought my children's results to a doctor and he said that thal major has been excluded and that if there is anything it would be thal minor.  I wanted to know whether the results pointed to thal minor or not but the doctor was unable to give a satisfying answer.  I went to a second doctor with all the results and he said that he did not find any indication of thalassemia. He also said that it would be better that we (my husband and myself) do all the blood test and we did exactly that.

As I have said, my husband's results are all within reference range but mine are not that good.  I wanted to go to the doctor last week buit he was not available.  I will try for this weekend.  In the meantime I would like to have your opinions if possible. My results are as follows:

HB: 11.6                  ref(11.5-16g)
RBC:4.84                 ref(3.8-5.8)
Haematocrit: 37.2     ref(38-47%)
MCV:76.8cu             ref(78-96)
MCII:23.9                ref(27-32)
Platelets:435           ref(150-400)
WBC count:6.5        ref(3.5-11)
Lymphocytes: 50     ref(20-40%)
Monocytes:8           ref(0-9%)

 I have read that If MCV is below 75 then it is indicative of thalassemia.  Does this value apply for all ages that is even for infants?

hope to hear from you soon.
Jade

Hi Jade, welcome to this site, slight change in MCV does not mean you can be thalassemic, Mean Cell Volume (MCV) is one red blood cell (RBC) indicator of hypochromic microcytic cells, diffrential diagnosis of these are many, among them most common are iron deficiency anemeia, thalassemia minor or may be even anemia of chronic disorders. Since you are a female, its very likely you can be iron deficient too. If you want rule out thalassemia carrier or minor, ask your doctor to request for hemoglobin electrophoresis or estimate hemoglobin A2 which is diagnostic test for beta thalassemia minor.

Thank you very much for your reply.

I did carry out electrophoresis and the results are normal .  I also carried out the iron ferritin test and the results are also normal.

Hi Jade,

Can you post the Electrophoresis results as well? If it shows High percentage of HbF and HbA₂ compared to HbA₁ (Though I'm not sure that HbF production in adults is still valid or not) then it is likely that you are Thal minima if you haven't experienced any symptoms.

Take care, Peace!

Thank you very much sajid for your prompt reply.

The electrophoresis result does not give details about the hbf ,hba and hba2.  It simply says '' HB electrophoresis at alkaline pH shows a Normal pattern".

Are high platelets and high lymphocytes count associated with thal?

By the way Sajid, what symptoms are you talking about?

 As a child, I have always been very healthy. I had one flu annually. But exercise was not for me.  I could never run (when I do I feel my lungs are on fire).
However, i remained quite small (stature) until 15 yrs old(late puberty).  I am still small (1m50) but I was faring well until I reached about 26 yrs when I started having flu more often.  As soon as the children catch it, I would also have it.  I cannot bend over for long since darkness sets in and my head aches.  For the staircases, I climb 3 levels and I feel tired (as compared to others).  Migraine also started at about 26 yrs old.
For my 2 pregnancies I did not have much problem except that my hb was not too high (nor too low)despite being on iron. 

Hi Jade,

I am talking about severe symptoms such as frequent infections and issues with gall bladder stones etc or anything that landed you in a hospital.

A couple of our members such as Kathy is Thal. Minor and had a tough life because of the severity of her Thal. Minor along with Sickle Cell trait. While another member Courtenay who is also Thal. Minor got her spleen enlarged and had to be removed.

You should not worry about the occasional flus and colds as long as it is not too serious.

Take care, Peace!

OMG!!!!  How did I find you all.  Please help I am so very tierd.  Now at 12yrs I was diagnosed with sickle cell disease after having frequent seizures and not being able to play without severe leg pain,back pain.  As an adult while carrying my son I was in intensive care with a blood infection but over came that.  I have always had bad episodes of pain and swelling, numbness and am still treted for some type of sickle cell. I have asked to go home and was told that I was sickling so bad untill I c/n be discharged.  I  have had a heart block, seizures , pnemonia x3 last year and a host of other problems.  I had a port placed years ago because of poor veins.

Last year I sent my lab results to Dr. Eckman in Georgia and they did call back stating that they were shocked at how the lab came up with the diagnosis of sickle cell trait, these test were done with a new doctor who said I was drug seeking in so many words. Dr Eckman felt that according to the lab report I faxed to him I had sickle beta Thalassemia and should find help asap. My neurologist stated that my EEG was very abnormal.
If I go to hosp today test will say positive, if I go next week dr will say you have nothing go home and seek help.  I am so.........tierd of this you just don't know.  I was declared disabled years ago due to my problems and hospital stays.  I recently saw yet another doctor who said your ferritin is low just take a multi-vitamin and you only have 41% of sickle cells.  You should have no problem.  She went on to say she was sending letters to my doctors and I asked that she allow me to share my own results when rudely said "well I sent your doctor a note stating you didnot want him to have the results"  I couldnot believe she did that.  Anyway, at times I cannot get out of bed , cannot walk seem to have a great deal of trouble with my right leg and hip .
My fingers /hands swell and get very dark in color and feel numb. I have even had the worst pain in my mouth one time and did get to e.r and was asked "did you know you had sickle cell disease?  for instance twenty five doctors....17  may say I have the
disease and 8 may say I don't.  Anyway please review the following test and let me know what you think and I will then find the appropriate doctor.  I do plan on going to Georgia to see Dr Eckman before year ending.  I could go on and on but I think you get the picture here oh and by the way  THANKS EVER SO MUCH AS I AM LAYING HERE WITH BAD CHEST PAIN UNDER MY RIGHT BREAST AND DON'T KNOW WHY.  ALSO THIS LAST DOCTOR SAID MY SPLEEN FELT A LITTLE ENLARGED.   I really APPRECIATE THIS SITE AND A HIGHER POWER DIRECTED ME HERE AS I HAVE DONE NUMEROUS RESEARCH AND NEVER FOUND YOU ALL.
WILL BE WAITING ON A RESPONSE EXCUSE SPELLING I'M SO NERVOUS JUST FOR FINDING THIS SITE.

                                                                  TEST RESULTS
Hemoglobin Variants HPLC with confirmation by IEF

TEST                                  IN RANGE                         OUT OF RANGE                                   REFERENCE

HEMO A                                                                     56.3 L                                                95.0--98.2

HEMO A2                                                                      3.8 H                                               1.8---3.2

HEMO F                                 0.5                                                                                          1. OR LESS

ABNORMAL HEMO 1                                                        39.4 H

ABNORMAL HEMO 2                                                           0

INTERPRETATION: Abnormal hemoglobin screen.  Abnormal hemoglobins are present and are identified as S by iscelectric focusing
The results are consistent with sickle cell trait. 

Have other results as well .


THANK YOU.....MEme

Hi Meme,

I'm sorry you've had so much trouble with doctors. Dr Eckman is a sickle cell specialist and would undoubtedly understand your tests better than most.  Have you had a hemoglobin electrophoresis test done? This would be able to tell you with more certainty whether you are a carrier of sickle cell, beta thalassemia or both. If you have had an electrophoresis done, I'd like to see the results. If not, I would suggest you do have one done. A hematologist should be able to read the results and confirm what traits you do carry.

Thank you ever so much for responding.  I am waiting on those test to be mailed to me as I drove 4-5 hours to see a doctor (hemo) who said I have nothing.  I'm so confused untill I am ready to give up PERIOD.  I know I have something because I suffer far to much and have many types of pain meds but at times I have to be admitted.  Most of the time my oxegen drops so low untill I am monitored allnite in hosp. It's just so upsetting when doctors don't agree and I don't know my father and my mom always masked all of her problems.   The only thing I can say about the electropheresis recently done was that 41% of my cells sickle and she said that means nothing more than the trait.  Will send results as soon as I receive them.

What is the ALLEN TEST??   Mine was positive but I don't know what it means. MCH 33.5 And lymph 44.5   wbc 7.4  rbc 4.03
it say SICKLE = POSITIVE

Hi Meme,

This report did confirm that you are a sickle cell carrier, as you are testing in the 40% range for sickle cell, which is definitely sickle cell trait.  However, the report is incomplete and beta thal minor cannot be concluded from these numbers. Normally with thal trait, the MCH is lower but yours is at the high end of normal. A more complete blood report would be of help.

The Allen test is used to determine the integrity of the blood supply to the hand. It is often done to see if only one artery is supplying blood to the hand. If a test is positive, it means that only one artery supplies blood to that hand. If the reading is positive, then an arterial puncture to determine oxygen levels in the blood, cannot be done in that hand.

There is a great possibility that the pain in your chest is related to the enlarged spleen. See if you can get a measurement of its size. The spleen enlarges from prematurely destroying red blood cells that it recognizes as abnormal, such as sickle cells or the small red cells found in thalassemia.

Sickle trait means one inherits one gene for normal hemoglobin A and one gene for defective hemoglobin S. People with sickle cell disease inherit a hemoglobin S gene from one parent and another abnormal hemoglobin from the other parent (i.e., Hemoglobin S, Hemoglobin C or Beta Thalassemia).

If you do also have the beta thal gene, it is called sickle cell beta thalassemia and the effects can widely vary.

From http://patients.uptodate.com/topic.asp?file=red_cell/24936

Among patients with sickle cell-beta thalassemia, the disease varies with the quantity of hemoglobin A, often being quite severe in patients with sickle cell-beta (0) thalassemia and less severe in patients with sickle cell-beta (+) thalassemia.

It would be best to be seen by a specialist such as Dr Eckman to get a better diagnosis than what you've had and to see if there is anything you can do to improve your health. You should be taking folic acid daily and stay well hydrated. Drink plenty of water.

Let us know when you get the rest of your test results.

Thanks Andy,

I do take the folic acid, last week I was told my ferritin was low and spleen enlarged.  That is exactly what I plan to do is se Dr Eckman because they supply you with documentation to carry around with you and I need that.  I will contiune to stay home in pain vs being treated in a nasty way and stared at.  What I don't understand is the inconsistency in testing.

Anyway thanks so very much....Will send results as soon as I get them I must find out why I suffer as I do.

meme,
my son is sickle cell beta thal.  it took 3 weeks in hospital to diagnose him as his blood cells do not look sickle cell through a microscope, but i dont know what test they eventually did but they confirmed sickle cell.  christians sickle trait comes from his father and the thal minor from me.  the two abnormal haemoglobins create sickle cell disease.  christian is on blood transfusions now and they aim to get his sickle pecentage to 30% or lower to avoid a crisis so i imagine at 40% you would be experiencing painful episodes.

christian's feet and hands would go black, bruise and he would be in severe pain.  his lower back was where he got a lot of crisis and this would lead him to stop walking for up to 10 days.  he would grunt in his sleep from the pain.  the sickle cells would block his lungs and he would be in extreme pain in the chest, he has gall stones and an enlarged spleen which they say in sickle cell patients they usually have an auto splenectomy, meaning the body detsoys its own spleen and gets rid of it. 

so meme i believe and sympathise with you.  we have never had a doctor question his diagnosis or frequent hospital visits, so i find it mind boggling that you are going through all this to find doctors who are on your side.  which country are you in??

regards vic.

Meme, good luck in finding the specialist


Vic, what you described is really terrible for a little boy, i am so sorry. Choosing to transfuse is really the correct decision

Andy,

The spleen enlarges from prematurely destroying red blood cells that it recognizes as abnormal, such as sickle cells or the small red cells found in thalassemia.

does spleen enlargement is due to this only or the spleen also under goes extramedullary hematopoesis???

Manal

Manal,

You are correct that the spleen (and other organs) can enlarge from extramedullary hematopoesis. However, this is most likely to occur under conditions of low hemoglobin. This is why it is more common for non-transfusing intermedias to have these masses in their bodies. They are also found in majors who continuously have low Hb. It is more unlikely, but not impossible, that a minor would have an extramedullary hematopoesis. They are generally related to Hb level. The lower the Hb, the more likely extramedullary hematopoesis can happen. This is why the first line of treatment for extramedullary hematopoesis is transfusion.

 I don't think Meme has supplied her Hb level. One more reason I want to see the full test reports.