Do low B12, folate, and T cells need hematology review?

Question

Hello doctor,

Should another consultation with a hematologist be conducted regarding no improvement in my blood work since the last time? It appears that the folic acid and B12 vitamins are not exactly working. Now T cells are dropping, as with CD4 and CD8. HIV remains undetectable. I believe that is ruled out?

1. Red blood cell folate 185.6 ng/mL is low.

2. Vitamin B12 265 ng/mL.

3. Absolute monocyte count (auto) 0.24 low.

4. MPV 9.1 low.

5. Platelet count 152 low.

6. Total T cells CD3+ 761 10E6/L low.

7. Total CD4 cells (CD3+ CD4+) 414 low.

8. Total CD8 cells (CD3+ CD8+) 348 10E6/L low.

9. MCH 33.5 high.

10. RBC 4.83 million/mm3.

11. WBC 5.17.

12. HIV-1 RNA VIRAL LOAD (copies/mL).

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Low CD count can be due to altered immune function or HIV. You have been investigated with the molecular tests for HIV. So after four to six weeks of exposure, it can definitely rule out HIV. If you have investigated early with a provided period, then you have to repeat your HIV testing. For low folate, you can be prescribed a folic acid tablet for one or two months.

For low vitamin B12, cyanocobalamine injection can be prescribed once a week for eight weeks. If you have any specific clinical complaints or history, then mention them to give further comment.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You should get your hemoglobin checked to rule out anemia. Since you are also experiencing bone and joint pain, further evaluation is needed, including tests like serum ANA, RA factor, and serum-free ionized calcium to identify any underlying cause.

For your weakness problem, it is advisable to investigate with serum TSH (thyroid-stimulating hormone) estimation, SGPT (serum glutamic pyruvate transaminase), SGOT (serum glutamic oxaloacetic transaminase) estimation, serum urea, and creatinine estimation. Your liver and spleen should also be palpated to exclude hepatosplenomegaly. You can take vitamin B12 in the form of an injection for rapid improvement. Folic acid 5 mg daily can be able to improve folic acid deficiency rapidly.

If your prostate cancer was of a high Gleason score, that is more than 8, then metastasis to bone should be ruled out by a bone scan. I suggest you consult a nearby physician for a detailed examination and discuss all these.

I hope this helps.

Kindly revert in case of further queries.

Thank you.