Q. Kindly have a look at my blood test and explain the reason for my multiple infections.

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Divya Banu M
Published on Jul 04, 2019

Hello doctor,

Age: 41, height 5'4", weight 110 lbs, Prozac 30, Wellbutrin, eletriptan, Vitamin D, Gabapentin, Dexidrine ER and IR, Synthroid, Cytomel.

Had second or last child eight years ago. Afterwards, had multiple infections (mastitis) and was on antibiotics almost the whole time I was breastfeeding. When I stopped breastfeeding, I started getting bad, daily headaches, lost a lot of weight quickly, post-partum depression. Diagnosed with Hashimoto's and chronic migraines, depression. Started anti-depressants, preventative and rescue migraine medicine, and Synthroid. Even after getting my depression managed, and thyroid fixed (at least the TSH was where they wanted to see it) I continued to have fatigue, daily headaches and low level anxiety and depression. I also developed symptoms of feeling like I was going to faint when standing up and racing heartrate, was diagnosed with POTS, working memory was non-existent and felt like I could not focus on anything, never knowing what to do first, I was like deer in headlights diagnosed with ADD and put on stimulants. I also have irregular periods and PMS is pretty bad. I feel like there is a hormone imbalance. All of these medical treatments have worked to a certain extent but there has been no discovery of the root cause and symptoms are just a bit better. They never go away.

Last week I had a blood test still trying to get to the bottom of my chronic symptoms. My thyroid came back a bit skewed. I am always tweaking this as it is very sensitive to medication change and my cholesterol a bit high, also normal.

My query is: There are blood markers that do not point to disease and I am not concerned that I have a scary illness lurking, but, I believe an imbalance that could be contributing to my overall health and symptoms. I am interested in looking more deeply into red blood cell information and how my liver, kidneys, blood is processing and fixing an imbalance. Some blood test results I would like you to look at and try to piece together: MCV and MCH run high. Hemoglobin and hematocrit run a bit low. Platelet count and RBC, C02 and bilirubin run low. Some Vitamins came up high which I found strange because I take a very standard multivitamin but only have for a few months. B6, B12, folate, folate RBC all were high. My appetite is not great so I worry I am not getting enough nutrients. I guess that is why I found it strange.

And finally, I am curious about my iron numbers. The most recent ones were not out of range but iron higher end and ferritin lower end. I have probably had four blood tests in the last few showing either iron or ferritin out of range changing between high and low or normal. Because I do not take Iron supplements and do no't get that much iron through my diet, my doctor ran a hereditary hemochromatosis test a year ago- that was negative. He could not explain the fluctuations but said I should look into it. I would be so grateful if you could analyze and let me know if you notice a pattern to my blood work that makes sense. Could it be some type of anemia or liver function issue? Anyway, I hope I can at least get closer to the source of my symptoms.

Dr. Parth R Goswami

Hematology Pathology
#

Hello,

Welcome to icliniq.com.

Sorry to hear about your health problem. Kindly answer the following questions to guide you further. Did you have fever anytime in these last few months? Do you have weight gain or weight loss problem? Have you ever undergone behavioural counselling? Is there any other associated symptom like leg edema, cough, chest pain? Do you have any reports available which shows lab values in numerical range?

Hi doctor,

Thank you.

Fever: A lot of times at the end of the day, I will feel cold and shivery and achy like I have a fever - even if it is warm I will need lots of blankets and sweatshirt. I say I feel feverish but I just feel kind of run down so I do not check my temperature.

Weight: My weight does not fluctuate a lot. Regardless if my TSH is high or low, I kind of stay between 110 and 115.

Therapy: I have recently but I did not feel like the therapist was a good fit. I have scheduled an appointment with one for next week that specifically deals with chronic illness.

Other symptoms. I rarely get colds or coughs. No chest pain. I do get water retention in my legs sometimes. It is probably not noticeable to others but is to me and puffy face and swollen tongue. I do not think my lymphatic system works all that well but I do self-massage and dry brushing. I bruise easily, heart palpatations come and go.

Dr. Parth R Goswami

Hematology Pathology
#

Hello,

Welcome back to icliniq.com.

I have checked your attached reports (attachment removed to protect patient identity). Following are my views of opinion for your case.

Your hemoglobin, platelet count, PCV are within range. So do not worry about that. MCH and MCV only slightly elevated, for which you need not to investigate further.

Your serum ferritin level is not low enough to labelled as iron deficiency anemia. Your hemoglobin is also within limit. So you are not having anemia. Your HDL cholesterol is high which is a good sign and do not worry about that. Your B12 and folate levels are high which can be due to Vitamin supplements. B12 is water soluble vitamin and readily excreted by kidney. So your B12 will fall mostly within range in next few days. Your liver and kidney function tests are normal.

For migraine, you need to avoid migraine precipitates like excess noise, bright light, hypoglycemia, lack of sleep, etc. The prophylactic treatment for migraine can be started if your doctor agrees. Rizatriptan like drug are the superior one to relieve headache in migraine acute attack. Unfortunately, there is no other way to treat migraine apart from life style change and medication. The light headache, dizziness, heart palpitation could be due to diagnosed POTS. You need to get treatment for that by cardiologist.

High salt intake, lots of water, compression sticking, beta-blocker medication, exercise under trainer's guidance are beneficial in such case. The large water intake is crucial in POTS to increase plasma volume. So increase water intake. It takes 2 to 5 years to completely get relief from POTS. You are having autoimmune thyroid disease as per history. So it can lead to chronic fatigue. Your TSH is on lower side. So you need to adjust dose of Levothyroxine by 75 instead of 100.

The fatigue, heart palpitation, unable to focus all can be aggravated by chronic anxiety or depression. So, you need to treat depression as a root cause for treatment. For that you should consult psychiatrist for detailed counselling and get treatment under psychiatrist guidance. The medication will shows benefit after 1 to 2 months. So, it needs to be taken for long time sometime 1 to 2 years.

During breastfeeding period, mastitis can occur due to staphylococcus. After lactation phase is completed, mastitis can never reoccur usually. You are giving history of easy bruising. For which you can be prescribed Vitamin C and get investigated for coagulation profile. However, occasional bruise does not need much attention. Hope all these points will help you to understand basic concepts of all disease you have. You can consult good nearby physician for primary evaluation and then physician will send you to the required specialist.

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