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Anemia CBC guidance. Low MCV, MCH, MCHC and Reticulocyte Count.

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Spleenpoker, Dec 7, 2018.

  1. Spleenpoker


    Hey all!

    Hoping some kind member can offer me some advice regarding my test results.

    I seem to be suffering from anemia symptoms and/or pots(among other things)
    My doctor said my blood work checks out but I don't believe that so would like to gain a bit more understanding for when I speak to a new doc

    For context: I am 27. Not sure exactly how much I weigh, but I am pretty skinny and I could never put on any muscle mass. Only fat I could ever put on was around my waist when I was on medication, lost that after stopping and never gained it back no matter how much I consumed.

    I eat very little protein daily(70-80g) as I have a terrible problem with sulfur/sulfites. I had to cut down my sulfur intake completely otherwise I'd have constant head pressure(tension migraines maybe?) almost constantly. After stopping all sulfur foods, finally some of my symptoms have reduced in intensity.
    This week I am busy increasing my red meat intake to see just how sensitive I am with a slightly higher protein intake.

    I am extremely sensitive to sulfite contaminated things, immediate brain fog(among other symptoms) from ingesting said contaminated items, eg Vitamin C, carbon filtered water. Even formaldehyde is a major problem, wet roller towel smell sets me off just as bad. I know Sulfite Oxidase and Aldehyde Oxidase are molybdenum enzymes but molybdenum supplementation barely improved my situation. I know that heme is a cofactor for those very same enzymes.
    I am also sensitive to numerous smells, both organic and synthetic. Spices cause huge mood swings and brain fog. Foods are a big problem too, still struggling to find the right combination of foods.

    I will list a few symptoms but there are just too many to even list:
    • My blood pressure is almost constantly 100/60+- sometimes /57.
    • Tachycardia after getting up. Have to wait a while before it calms down.
    • I get post meal fatigue around 30-45 minutes after eating, depending on meal size, currently my meals are tiny. Which makes me eat smaller meals more frequently. Again, depending on meal size I might get brain fogged, lose comprehension, concentration and motivation. Even lying down for an hour does nothing to help.
    • Dark circles under my eyes since I was 12, which won't ever go away. (I have no actual allergies)
    • Insanely heightened sense. Light, sound and smell sensitivity. So doesn't help that I react to smells but now I can smell them even better :/
    • My sleep cycle is completely messed up, sometimes end up going to bed 3am. I wake up fine, with some energy but after my first meal(small) and throughout the rest of the day(after every meal), I just get more and more fatigued.
    • I alternate between constipation, diarrhea and "normal stool shapes"
    • ***Likely most important clue, perhaps?*** - A few months ago my stools became completely yellow and I just can't get them brown again.I have tried Taurine supplementation and all it does is give me gallbladder pains after consumption which has never happened before or even after stopping it, not even with a very fatty meal.

    Here are the links to my results.

    CBC, Iron, ESR, Reticulocytes, Haemoglobin Electrophoresis:
    *The following are on or below the reference range:
    MCV, MCH, MCHC and Absolute Reticulocyte Count.

    Ammonia, Homocysteine:


    Electrolytes, Urate, Urea:


    Lipogram, Cholesterol, C Reactive Protein, Glucose Fasting Blood, Liver Function Test:

    I had a more recent bilirubin test done, figures have risen somewhat:

    Does my liver function tests point out anything wrong with my bile flow? Maybe it's more of a heme issue only and nothing to do with bile salts themselves? That would line up with my anemia symptoms then if it's just heme related.

    Soluble Transferrin Receptor:

    I already did an oxalate 24 hour urine test 3 months ago, I wasn't eating excessively high amounts of oxalate high foods at the time though. Here are the results:
    This is a few months after my stools went yellow and I was still consuming 50g+- of fat daily(Mainly saturated fat from meat and ghee)

    I have no idea what type of anemia I am suffering from or whether I could treat it. If I need to synthesis more heme, if so, how would I even go about that? I have been recommended B6 a few times for heme synthesis but I am a bit worried that the B6 will just increase my sulfur burden, as I have read it can induce CBS. Though I assume that's only really a problem if homocysteine is draining down your transsulfuration pathway?

    Many thanks. Any and all advice is welcome!
    Last edited: Dec 7, 2018
  2. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

    • You are NOT anemic. Your hemoglobin and hematocrit are fine.
    • Your Mean Cell Volume (MCV) is 81 with a reference range of 81-95. This indicates borderline microcytosis (small red cells). Typically microcytosis is due to low iron, but your iron level is fine.
    • The low Mean Cell Hemoglobin (MCH) is due to the small size of your red cells. Your result was 27 with a ref. range of 28-35.
    The following article might be helpful:
    Evaluation of Microcytosis

    First check Table 4 to see if any of the suggested diagnoses make sense.

    Then follow this algorithm. You've had all of the diagnostic tests.
    Laboratory Tests in the Differential Diagnosis of Microcytosis

    Another article that could help you:

    The chart at the bottom of this page may be helpful:

    The results from your CBC show that:
    • your Red Blood Cell color is Normochromic [normal Mean Cell Hemoglobin Concentration (MCHC)] and
    • your Red Blood Cell size is Microcytic to Normocytic (borderline Microcytic) 81 (81-95)
    • you are not anemic (normal hemoglobin and hematocrit)
    My brain has fizzled out and I can't make an interpretation (seems to be above my pay grade). @valentinelynx do you want to take a shot at this?
    Last edited: Dec 8, 2018 at 2:21 PM
  3. Spleenpoker


    Thank you for the response @CFS_for_19_years

    I will give the articles a look.

    I would love to hear @valentinelynx thought's about this too.

    I will only be able to see a hemeotologist in the new year so all the advice is welcome while I do some research to discuss with them.

    Thanks again.
  4. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

    I'm glad you're seeing a hematologist. I couldn't say "Ah ha, that's what you've got" by checking off any of the boxes. Now you can impress them with your vocabulary of normochromic microcytosis.

    Spleenpoker is an interesting name considering your red cells are being investigated. The spleen is where old red cells go to die. The blood vessels in the spleen are the smallest of any place in the body so if they don't survive being squished there, their membranes break up. Keep in mind that a red cell lives about 120 days, so it survives a lot of trips through the spleen before giving up. People missing their spleens have a lot of odd looking red cells that the spleen would normally cull. (A spleen can be given up during surgery.)
  5. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits


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