HomeAnswersHematologyhashimoto's thyroiditisKindly explain my abnormal CBC values with Hashimoto's disease.

I have Hashimoto's disease with raised monocytes and low hemoglobin. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At October 7, 2020
Reviewed AtOctober 7, 2020

Patient's Query

Hello doctor,

I have autoimmune issues (Hashimotos 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 is raised to 80 over the last five years, and my CRP is 6.

Last year my platelets 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 day time, but I have a chronic cough like allergy 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?

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 platelet, 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 is low. It could be associated with Hashimoto thyroiditis like 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 platelet, and borderline low WBC might be due to that.

The third possibility is an enlarged spleen. Hypersplenism can cause a low level of all these three mentioned 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. Viral infection can sometimes cause elevation of monocyte. TB is also responsible for the elevation of monocyte. A chest x-ray should be done as per my opinion for further workup.

I hope this helps.

Patient's Query

thankyou Dr Parth ive received your detailed response and appreciate. I have had low ferrertin and borderline low haematicrit for some years . and low Hb i feel well I use biodientical Thyroid hormone for my Hashimotos and usually levels are good just waiting on new results. thanks for calculating esonophil absolute :) monocyte yes I will have a chest x-ray as I live in Indonesia and have had a chronic cough on and off for some time ( mildly productive) interestingly the last week I took twice an antihistamine and it's 95% ceased ...so . maybe allergies I did have mould exposure a couple of years ago I've also just found out I have a chronic infection under a dental bridge it will be removed may slo help. would you suggest seeing a general practitioner to palpate my spleen or an endocrinologist re the total.picute or wait take iron and retest. low platelets are new this year the iron components have been low and borderline for some years. many thanks AnnaMaree Ah I didn't realise I couldn't reply without paying again so im hoping the 50 HR chat doesn't have s cut off date :) it's several.motnhs no income due to covid. so I will use my credit with you as I need and many thanks

Hello welcome back. you don't need to pay further for next 50 hour you can ask questions till next 50 hour You can consult good physician at least who had done MD medicine to palpate your spleen and discuss management plan Ferrous ascorbate tablet can be started for your iron deficiency anemia. (Your ferrtin is low and hb low, pcv low so it could be iron deficiency anemia) Hope I have answered your question Let me know if I can assist you further Regards

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Goswami Parth Rajendragiri
Dr. Goswami Parth Rajendragiri

Pathology

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