Dr. Muhammad Zohaib Siddiq
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 21-year-old female and recently got a CBC test. It turns out my hemoglobin level is 11.5 g/dl, but my RBC count is 6.2. MCV is 60.4, MCH is 18.5, MCHC is 30.7, the platelet count is 39700, and WBC levels are normal. I have normal thyroid profile but depleted vitamin D (0.3). I recently took one capsule of Vitamin D 60k IU and soon after started experiencing a bounding pulse in many places on my body. The pulses are so strong that when it vibrates or forcefully beats the skin over, it jumps for the duration. Also, there is a small area near my ankle that becomes weirdly hot from time to time (same area), and just one time, I experienced the same sensation on my forearm. Please answer my queries below. Should I discontinue the Vitamin D capsule, although my levels are very low, and switch to natural sources like sunlight and natural food since I have seen on many platforms that excess dosage of Vitamin D supplements has caused palpitations and related problems? Should I be concerned about any blood clots due to those abnormal pulses and heat sensations? Is there something wrong with me since my RBC count is quite high? Thank you so much for your time.
Hi,
Welcome to icliniq.com.
Yes, you may continue Vitamin D, but if it causes the same symptoms repeatedly, you should switch to another formulation route. Peripheral pulses do not cause clots. In fact, heart rhythm abnormalities can cause clot formation inside the heart. If you have palpitations, get ECG (electrocardiography) done. Your MCV (mean corpuscular volume) is low as compared to RBCs (red blood cell) and Hb (hemoglobin). Mentzer Index is looked to differentiate between iron deficiency anemia and thalassemia. Your Mentzer index is around 10. Mentzer index less than 13 is more in favor of thalassemia rather than iron deficiency. That is why I am recommending hemoglobin electrophoresis.
Patient's Query
Hi doctor,
Thank you for your reply. I had my ECG, and 2D echo done before starting the supplement, like 20 days back. They were normal. Do I need to get them done again? Also, I had a severe panic attack last week, and my heart was beating very loudly and felt like it was wiggling at times. Is it a heart-related concern? Also, none in my family was ever diagnosed with thalassemia. Is it a serious condition? I have attached my mom's blood report. My father's reports are all within range. Can you conclude thalassemia from my mother's reports, or should I go for the test?
Hi,
Welcome back to icliniq.com.
This CBC (complete blood count) also shows a Mentzer index of less than 13 and is thus in favor of thalassemia. Moreover, LDL (low-density cholesterol) is high.
Patient's Query
Hi doctor,
Thank you for your reply. Could you please tell me what the cause of the bounding pulse I am experiencing might be? Is it something potentially dangerous? I had gotten ECG, and a 2D echo was done, but nothing came from it. But it has caused me a lot of anxiety. I had done deep phenol chemical peeling on my upper back for three sessions about three months ago. Would it have messed with my heart? Is it arrhythmia or atrial fibrillation? Since I have been experiencing palpitations occasionally, but my parents do not seem to be experiencing any of that.
Hi,
Welcome back to icliniq.com.
Anemia is one of the causes of bounding pulse. Fast heartbeats also cause this. Other causes are valvular heart disease, thyrotoxicosis, pregnancy, certain vitamin deficiencies, fever, and anxiety. Chemical peeling is only on the skin. It cannot mess with the heart. Palpitations are subjective feelings. ECG (electrocardiography) should be done when one feels palpitations, or Holter monitoring should be done to tally symptoms with ECG (electrocardiography) changes.
Patient's Query
Hi doctor,
Thank you for the reply. But since only one of my parents has thalassemia, there is no chance of having thalassemia intermedia or major, right? I do not have any symptoms of fatigue, and neither does my mother. Should I reduce or increase iron intake, or do I need supplements in my case? Will I live a long, healthy life, or does it put me at risk for other diseases? since my grandparents and everyone else from my mother's side have lived long and healthy. Also, can you please tell me if I have to avoid or reduce any foods or activities that could worsen it? I also had pain on the left side of my chest, for which I had ECG (electrocardiography) and echo done, but after taking a Vitamin D supplement, it went away. Is that linked to thalassemia or spleen or just the deficiency?
Hi,
Welcome back to icliniq.com.
First, it has to be diagnosed with thalassemia or iron deficiency. For that, have Hemoglobin electrophoresis done. If it detects thalassemia, no medicine, just on and off iron supplements and other supplements, and Influenza vaccination. If there is no thalassemia, then iron profile. If there is an iron deficiency, then take iron supplements. Diagnosis of thalassemia is a must because if it is thalassemia minor, your to-be husband must be tested for thalassemia minor. Because both spouses are thalassemia minors, then 25 percent chance of children being thalassemia majors. Thalassemia minor patients can live a normal life. Only occasionally may they need a blood transfusion.
Patient's Query
Hi doctor,
Thank you for answering a lot of my queries. You said that peripheral pulse cannot cause a clot in the heart, but I can feel the bounding pulse very close to the heart as well, it is confusing whether it is palpitations or bounding pulse sometimes. Is it something I should worry about (like clots in the heart)? This started after taking the Vitamin D pill 60k IU. Before that my ECG and echo were normal. Are these bounding pulse or palpitations temporary, like merely the side effects of supplements or anemia or is it a chronic condition? Also, why am I experiencing those hot areas on my body for a few seconds, is it right to correlate that with my other symptoms, or what could be the cause?
Hi,
Welcome back to icliniq.com.
Palpitations are unusual subjective feelings of beating heart. The bounding pulse is different. It is a peripheral pulse whose volume is high. This can occur in the conditions mentioned above. Hot flashes can be due to anxiety but are also caused by vitamin D deficiency. Your ECG and Echocardiography were normal, so there is no need to worry. Bounding pulses depend upon their cause. Once the cause is gone, pulses become normal.
Patient's Query
Hi doctor,
Thank you for the reply. Is there any chance of having a thalassemia major or intermedia? These are my dad's reports. My concern is if it is just thalassemia minor, I can get tested at the time of getting married or serious, but if it is thalassemia major or intermedia, I might have to get it done urgently. Can I rely on the Mentzer index alone in my dad's case and stay unworried that just one parent is a thalassemia carrier? Is it possible for thalassemia intermedia patients to be asymptomatic for two decades?
Hi,
Welcome back to icliniq.com.
This report is normal (attachment removed to protect the patient's identity). For diagnosis, a hemoglobin electrophoresis test is to be done. Yes, you and your husband should get tested for thalassemia with hemoglobin electrophoresis to save future generations from lifelong illness. From reports, it seems thalassemia minor.
Patient's Query
Hi doctor,
Thank you for the reply. So if just one parent is a thalassemia minor, there is no chance of a baby having a thalassemia major. Is there any chance of the baby having thalassemia intermedia if one parent is a thalassemia minor?
Hi,
Welcome back to icliniq.com.
Yes, there is no chance of getting thalassemia major and thalassemia intermedia. There is a chance only for thalassemia minor.
Patient's Query
Hi doctor,
Thank you so much for your response.
Hi,
Welcome back to icliniq.com.
You are most welcome.
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Cardiology
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