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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.

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#

Hi,

Welcome to icliniq.com.

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.

#

Hi,

Welcome back to icliniq.com.

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.


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