I have numbness in hands with positive RA factor, low TLC and platelets. Please help.

Question

Hi doctor,

I am a 42-year-old female. I am having hand numbness and on the below medicine. But still no improvement. I have performed some lab tests.

Hemoglobin 18.2.

Packed cell volume (PCV) - 53.

RBC count - 5.88.

Total leukocyte count (TLC) - 3.9.

Platelet count - 140.

HbA1c - 5.2.

Estimated average glucose (eAG) - 103.

Erythrocyte sedimentation rate (ESR) - 80.

Anti-nuclear antibody/Factor (ANA/ANF) - 27.88.

Anti-streptolysin-O (ASO) titer, serum @ 90.0.

Vitamin B12, Cyanocobalamin - 270.7.

Vitamin D, 25-hydroxy, serum - 6.78.

My current medications are Alenac-MR, capsule. P25- D, tablet Predmet 4 (zempred 4), and Salday (Sazo 1000).

Answer 1

Hi,

Welcome to icliniq.com.

I hope you have met a rheumatologist personally also. Because she is suffering from arthritis, her rheumatoid factor is positive, and blood reports do not seem good as the TLC (total leukocyte count) and platelets are low, and hemoglobin is high. Does she have a history of high Hb? She needs to be on proper medication for RA, and her Salday needs to be stopped. Vitamin D and calcium supplementation needs to be regular, and she need a higher dose of Zempred maybe 16 mg for the time being along with HCQs (hydroxychloroquine), following which CBC (complete blood count) will be repeated and if TLC is normal Methotrexate will be started. Also, we need to check her ANA (antinuclear antibodies), IFA (immunofluorescence) and ENA (extractable nuclear antigen) qualitative, anti CCP and urine routine examination. Maybe also a chest x-ray needs to be done.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

You will need to increase the dose of Zempred (Methylprednisolone) to 16 mg, stop Salday, and start Hydroxychloroquine 200 mg daily. Take a supplement of Folic acid, vitamin B12, Calcium, and vitamin D. Recheck CBC, ANA, and IFA after a week, then the dosages may be modified.

Thank you.