Dr. Goswami Parth Rajendragiri
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My hemoglobin level is low. My ferritin level is at high 959.7 mg/ml. My hemoglobin levels is same even after taking three units of blood in the last month. It is still 6 g/dl. Last month my is ESR 32 and now it is 110, platelet count 128000 last month and now it is 60000, WBC count 4300 last month and now it is 2300. TSH is 1.79 and iron level is 238.5.
I am currently taking Folvite, Rifagut 400 mg, Dytor 5 mg, Xytid CV, Cremaffin plus 15 ml, Udiron 300 mg, Blong F, injection Heliopenam.
Hello,
Welcome to icliniq.com.
I have read your reports (attachment removed to protect patient identity), and following is my opinion for your asked question.
In your attached report, reticulocyte count and bilirubin level are high. Ferritin is also high. Liver and spleen enlarged in USG (ultrasound) scan. So you could probably have hemolytic anemia.
In this condition, red blood cells are constantly getting destructed in our blood due to some causes. Hence, hemoglobin level goes down. Sometimes it includes platelets component as well, so platelet level can go down.
There are many causes for hemolytic anemia like for example, autoimmune hemolytic anemia for which Coombs test can be done. G6PD deficiency, spherocytosis, PNH (paroxysmal nocturnal hemoglobinuria), etc., are some other causes for hemolytic anemia. So you need to visit a nearby hematologist for detailed physical examination according to which further management plan decided.
I hope this helps.
Patient's Query
Thank you doctor,
I have visited a nearby hospital and consulted with a hemotologist in there. He asked me for a Hb typing test but as I received blood last month, so I could not do that. He asked me to wait for three months and given some medicine like Folvite, Bevon and some liver tonics. In your opinion, what should I do in this three months time?
Hello,
Welcome back to icliniq.com.
Your hemoglobin level is very low. So for hemolytic anemia full workup can be done. You can investigate with Coombs test, ANA (antinuclear antibody) testing and HB electrophoresis after a few weeks.
You have hemolytic anemia but the cause is not clear for which you need to investigate in detail especially with coombs test and HB electrophoresis. Additionally, G6PD qualitative test can also be done. The management can be planned once the above reports are done.
I hope this helps.
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Pathology
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