Q. Can you see the attached CBC report, and let me know if there is anything serious ?

Answered by
Dr. Parth R Goswami
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 27, 2018 and last reviewed on: Oct 09, 2018

Hi doctor,

My wife's iron and ferritin were low, so the doctor ordered CBC. CBC showed low WBC, high monocytes, and high RBC, which is what made us scared.

She has schistocytes and elliptocytes among other RBC morphologies. We read about it and are very worried, and she had a C-section three years back. Her iron is 13 ug/dL, iron binding is 484 ug/dL, iron saturation is 3 %, and ferritin is 3 ng/mL. I have attached her CBC report.

Are her reports indicative of something serious?

She also has pain between her legs and the pelvic area. She has vitamin D deficiency and vitamin B12 deficiency. She also had iron-deficiency anemia in the past, for which she took Ferrous sulfate. She is currently taking vitamin D and Thyrax medicines.

Dr. Parth R Goswami

Hematology Pathology


Welcome to icliniq.com.

I have gone through your wife's reports (attachment removed to protect patient identity).

The report shows schistocytes, which are fragmented RBC (red blood cell), commonly seen in hemolytic anemia. So, to rule out hemolysis, serum LDH (lactate dehydrogenase), reticulocyte count, and serum bilirubin should be tested.

If hemoglobinopathy is suspected, then HPLC (high-performance liquid chromatography) can be done.

As there is a history of iron-deficiency anemia (IDA), which decreases the iron level and increases TIBC (total iron binding capacity). So, treatment for IDA should be started with iron tablets like Ferrous sulfate or iron injections.

Her monocyte count is slightly elevated, but absolute monocyte count is more important which is within the normal limits.

Total WBC count is low, which can be due to any drug, infections like tuberculosis, typhoid, parvovirus B19, temporary infection, EBV (Epstein-Barr) virus infection, etc. Hence for that clinical examination and correlation has to be done.

But in smear, no abnormal cells are seen, so there is nothing alarmingly wrong.

Continue treatment for iron-deficiency anemia. Repeat peripheral smear after ten to twenty days and follow-up.

Revert after twenty days to a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

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