How to treat Hashimoto's disease with raised monocytes and low hemoglobin?

Question

Hello doctor,

I have autoimmune issues (Hashimoto's and complete alopecia). For the last few years, my annual CBC has shown raised monocytes and eosinophils. My latest monocytes are 9.9 % and eosinophils 5 %. I have had low hemoglobin for years. My ESR has risen to 80 over the last five years, and my CRP is 6.

Last year, my platelet level was good. But this year the level is decreasing. I take a good diet rich in greens and vegetables, and I do not have unusual bruising or petechiae. No fatigue in the daytime, but I have a chronic cough, suspected to be a postnasal drip. I have no aches and pains, and I am in my menopausal period. Can you shine a light on my CBC report?

Kindly guide.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

Following is my opinion about your case.

In your attached complete blood count (CBC) (attachment removed to protect patient identity), the important findings are low Hb (hemoglobin), PCV (packed cell volume), low platelets, high RDW (red cell distribution width), high eosinophils, and high monocytes.

Following is my explanation for that.

Low Hb, PCV, and high RDW are suggestive of anemia, particularly iron deficiency anemia (IDA). However, you can do further workup in the form of ferritin estimation, TIBC (total iron-binding capacity) estimation, and iron estimation to confirm IDA.

Anemia can be associated with Hashimoto thyroiditis like autoimmune disease.

Your platelet count is low. It could be associated with Hashimoto thyroiditis, like an autoimmune disease. The reason could be immune thrombocytopenic purpura (ITP), in which antibody attacks our own cells, like thyroid gland cells and platelets. So it might be due to ITP.

The second possibility is bone marrow suppression by thyroid dysfunction. All hematopoietic cells are produced in the bone marrow. So your anemia, low platelets, and borderline low WBC might be due to that. The third possibility is an enlarged spleen. Hypersplenism can cause a low level of all three of these cells.

The third possibility is an enlarged spleen. Hypersplenism can cause a low level of all three of these cells.

So, to control your Hashimoto thyroiditis and thyroid hormone level with medication, discuss the management with your endocrinologist. It is good that bleeding is not present, so there is no alarming worry about that, and discuss with the endocrinologist.

Iron tablets should be started if iron deficiency is confirmed. Your AEC (absolute eosinophil count) is within the range. Your cough might be the cause of high monocyte counts. Viral infection can sometimes cause an elevation of monocytes. TB is also responsible for the elevation of monocytes. A chest X-ray should be done, in my opinion, for further workup.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I can understand your concern.

You can consult a physician, to palpate your spleen and discuss a management plan. A ferrous ascorbate tablet can be started for your iron deficiency anemia. Your ferritin, packed cell volume, and hemoglobin are low, so it could be iron deficiency anemia. Let me know if I can assist you further.

I hope this information will help you.

Thanks.