Q. What could make a person feel sick despite his blood reports being completely normal?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by Dr.P.C.Pavithra Pattu
This is a premium question & answer published on Jul 04, 2022

Hi doctor,

I have been experiencing extreme tiredness, dizziness, and shortness of breath. Also, I have painful feet soon after waking up. I had the same issue 14 years back. My hematocrit value is 49 %, my hemoglobin is 16.44 mg/dL, RBC is 5.48 million cells/mcL, calcium is 2.61 mg/dL, and total protein is 85 g/L. My doctor refuses to do any further investigations. I feel sick. But she says that my blood is excellent. Is it advisable to visit a hematologist? Kindly suggest.



Welcome to

Hopefully, you did well in the pandemic. I went through all of your data. Your biochemical parameters are slightly out of the reference ranges but not clinically significant and would not give you any symptoms. However, your hemoglobin is somewhat high and could cause mild high blood pressure problems. It is essential to maintain good hydration for a few days and recheck your hemoglobin and hematocrit values. Please read the following regarding elevated hemoglobin for a better knowledge:

Elevated hemoglobin is seen in smokers, people living at high altitudes, those with congestive cardiac failure, chronic obstructive pulmonary disease, some erythropoietin secreting adenomas of the kidney, and very rarely, it could be a part of primary polycythemia. Rule out the causes of secondary polycythemia. If all causes are excluded, get tested for JAK2 (Janus kinase 2), Exon12, and CALR (calreticulin) mutations. Even in primary polycythemia, also called polycythemia rubra vera, these mutations are negative frequently.

In cases of secondary polycythemia, the treatment of elevated hemoglobin is to treat the cause. In primary polycythemia, if JAK2 is negative, the treatment is therapeutic phlebotomy or venesection. The goal is to keep hemoglobin and hematocrit within the range. That is for males, less than 50 % hematocrit, and for a female, less than 48 %. And the hemoglobin in males is 16 g/dL, and then in females, up to 15 g/dL. It can be combined with hydroxyurea. Its dose could be calculated according to the weight of the patient. Repeated venesections or phlebotomies can lead to micronutrient deficiency, especially iron. The patient should be given micronutrient replacement therapy. For JAK2 positive patients, Ruxolitinib (Jakavi) tablets are given at a dose of 5 to 15 mg daily. Another option is IFN Alpha (Pegasys) in low dose (45 μg/week) in both JAK2 positive and negative cases. CALR positive cases show superior results. It could take years to cure the disease. Meanwhile, along with all therapeutic modalities, thrombophilia prophylaxis is given. This is not a life-threatening disease. The patient can die with this but does not die of it.

I hope this has clarified your doubts. Thank you.

Hello doctor,

Thanks for your reply.

I am not dehydrated and I drink enough water, but I feel tired and short-breathed for a month now. The test was taken twice, with both times the same results. Kindly suggest me a solution.



Welcome back to

I have gone through your query and looks like some workup is needed. I need some information on your smoking habits, like whether you smoke and how many cigarettes you smoke a day. I have mentioned the tests that need to be performed below:

1. To get an echocardiogram done.

2. Spirometry test.

3. JAK2 mutation test.

4. Erythropoietin test.

Kindly get back to me with the results.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
I just got the results from my blood tests, and I was told that I have a fatty liver. What to do?

.. your concern. I have gone through the reports and some parameters are slightly high. But I do not find anything abnormally wrong in the reports. Your creatinine and urea are normal and it indicates that the kidney is in healthy condition. Your hem...   Read full

From the attached reports, please tell me the reason for frequent urination.

If these tests are positive, then you will need a water deprivation test for a day, which will confirm that it is diabetes insipidus ...  This condition is called as diabetes insipidus ...   Read full

Please provide opinion on my complete blood count report.

.. the mentioned history hemoglobin level is low and MCV (mean corpuscular volume) is high, So macrocytic anemia is present (attachment removed to protect patient identity). The cause for which has to be ruled out. Hypothyroidism, vitamin B12 deficie...   Read full


Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

Balantidiasis - Causes, Signs and Symptoms, Diagnosis, Treatment, and Prevention
Balantidiasis is a rare bacterial infection caused by a parasite called Balantidium coli. Read the article below to know...  Read more»
JAK Inhibitors in Treating Rheumatoid Arthritis
Doctors mainly suggest JAK or Janus kinase inhibitors for patients with rheumatoid arthritis to ease their symptoms. Rea...  Read more»
Importance of Sex Hormones - Types, Functions, Normal Ranges, and Roles
Sex hormones are steroids produced in the body that control sexual development, pregnancy, and overall health. Read belo...  Read more»

Ask your health query to a doctor online?

Ask a Hematologist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.