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

Question

Hello doctor,

I had my second or last child eight years ago. Afterward, 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, and had postpartum depression.

I am diagnosed with Hashimoto's, chronic migraines, and depression. I 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 a racing heart rate. I was diagnosed with POTS, working memory was non-existent, and I felt like I could not focus on anything, never knowing what to do first. I was like a 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 the root cause has not been discovered, 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 is 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 there is 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, and 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 I have only had it for a few months. B6, B12, folate, and folate RBC were all 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 had a higher end, and ferritin had a 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 not 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 my blood work and let me know if you notice a pattern that makes sense.

Could it be some anemia or liver function issue?

Anyway, I hope I can at least get closer to the source of my symptoms.

Please guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Sorry to hear about your health problem. Kindly answer the following questions to guide you further.

Have you had a fever in the last few months?
Do you have a weight gain or weight loss problem?
Have you ever undergone behavioral counseling?
Is there any other associated symptom, like leg edema, cough, or chest pain?
Do you have any reports available that show laboratory values in a numerical range?

Please answer the questions and consult again.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have checked your attached reports (the attachment was removed to protect the patient's identity). The following are my views on your case.

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

Your serum ferritin level is not low enough to be labeled as iron deficiency anemia. Your hemoglobin is also within the limit. So you are not having anemia. Your HDL cholesterol is high, which is a good sign, and do not worry about that.

Your vitamin B12 and folate levels are high, which can be due to vitamin supplements. B12 is a water-soluble vitamin and is readily excreted by the kidneys. So your B12 will fall mostly within range in the next few days. Your liver and kidney function tests are normal.

For migraine, you need to avoid migraine precipitants like excess noise, bright light, hypoglycemia, lack of sleep, etc. The prophylactic treatment for migraine can be started if your doctor agrees. Rizatriptan-like drugs are the superior ones to relieve headache in an acute migraine attack.

Unfortunately, there is no other way to treat migraines apart from lifestyle changes and medication. The light headache, dizziness, and heart palpitations could be due to diagnosed POTS. You need to get treatment for that from a cardiologist.

High salt intake, lots of water, compression stockings, beta-blocker medication, and exercise under a trainer's guidance are beneficial in such cases. Large water intake is crucial for POTS to increase plasma volume, so increase water intake.

It takes 2 to 5 years to completely get relief from POTS. As per your history, you have autoimmune thyroid disease, which can lead to chronic fatigue. Your TSH is on the lower side, so you need to adjust the dose of Levothyroxine by 75 instead of 100.

The fatigue, heart palpitations, and inability to focus can all be aggravated by chronic anxiety or depression. So, you need to treat depression as the root cause for treatment. For that, you should consult a psychiatrist for detailed counseling and get treatment under a psychiatrist's guidance. The medication will show benefit after 1 to 2 months. So, it needs to be taken for a long time, sometimes 1 to 2 years.

During the breastfeeding period, mastitis can occur due to Staphylococcus. After the lactation phase is completed, mastitis can usually never recur. You are giving a history of easy bruising. For which you can be prescribed vitamin C and get investigated for a coagulation profile.

However, an occasional bruise does not need much attention. I hope all these points will help you understand the basic concepts of all the diseases you have. You can consult a good nearby physician for primary evaluation, and then the physician will send you to the required specialist.

I hope this helps.

Please follow up if you have any doubts.

Thank you.