Dr. Goswami Parth Rajendragiri
Pathology
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Patient's Query
Hello doctor,
Should another consult with hematologist be conducted regarding no improvement on my blood work since 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 whereby, I believe that is ruled out?
1. Red blood cell folate 185.6 ng/mL 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).
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 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 it to give further comment. I hope this helps.
Patient's Query
Thank you doctor,
I have the symptoms of occasional fever and chills, fatigue, weakness, bone and joint pain and night sweats. Currently, I am taking 2000 mg vitamin B12 daily and 1 mg folic acid daily. I have been HIV undetectable for 10 years while on the current regiment. I did have prostate cancer 18 months ago, and the prostate was removed.
Hello,
Welcome back to icliniq.com.
You have to check your hemoglobin level to rule out anemia. As you are having bone pain and joint pain you have to investigate,
1. Serum ANA estimation.
2. RA factor estimation.
3. Serum-free ionized calcium estimation.
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 also should be palpated to exclude hepatosplenomegaly. You can take vitamin B12 in the form of injection for rapid improvement. Folic acid 5 mg daily can be able to improve folic acid deficiency rapidly.
If your prostate cancer was of high Gleason score, that is more than 8 then metastasis to bone should be ruled out by bone scan. I suggest you consult a nearby physician for a detailed examination and discuss all these.
I hope this helps.
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Pathology
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