My Hb is around 12. Should I seek bone marrow aspiration?

Question

Hello doctor,

I am a 25-year-old man without major systemic diseases before. I am actually a medical student now. During the general examination this year, I noticed my Hb level around 12 to 13 g/dL. Follow up data in the following months showed 12.7 > 12.8 > 12.4 > 12.6. Normocytic (84), borderline hypochromic (31.5) with borderline Hct (38.5 %) during the last examination. WBC and PLT were both within normal limits and I also had normal differential count with no blast cell. Other lab data like total protein, albumin, ferritin and stool occult blood were all within normal limits. Due to these problems, I looked back for my past examination history and found an examination seven years ago (when I was 18-year- old) showed also Hb level around 12.6 g/dL with similar other laboratory data. HbEP was also arranged for further survey and revealed Hb A 97.8 % and Hb A2 2.2 %.

The reticulocyte count during the last examination showed 1.3 %, which would be bone marrow hypo-proliferative if I corrected it with reticulocyte index. I wonder whether I have some bone marrow problems and seek for bone marrow aspiration. Or, is it just not suitable to use reticulocyte index to calculate reticulocyte when my Hb level was only a little bit below the normal limits? (RBC count = 4570000/microL, absolute reticulocyte count was normal).

Can Hb 12 to 13 g/dL be a normal variant in a generally healthy young adult? What other differential diagnosis do I have to keep in mind?

Answer 1

Hello,

Welcome to icliniq.com.

You are a medical student, so obviously you are very much alert about health. I have reviewed your query and here is my advise.

Your CBC (complete blood count) report is not showing any abnormality except borderline hemoglobin level. You are right in that the male hemoglobin range is within 13 to 17 normally. But, do not worry about your Hb level, it is mildly low.

You can take iron-rich foods like red meat, green leafy vegetables, beans, jaggery, etc.

Provide me your serum ferritin value to check it. Your reticulocyte count is within range and I do not think you have to worry about hypo proliferative anemia. After taking iron rich foods you can repeat reticulocyte count.