Are low MCV and MCH levels due to thalassemia?
Patient's Query
Hello doctor,
I am a 35-year-old male with no past medical history and on no medications. For the past five years, I have maintained a hemoglobin range of 13.6 to 14.4 g/dL on yearly physicals but always had a low MCV and MCH range. My RDW is always normal, and my RBC count is in the high normal range, and the last one was 5.5 million cells/mcL when Hb was 14.3 g/dL. This time I finally got a hemoglobin electrophoresis and iron studies, which came normal. I have attached the reports for the same. I have no known family history of thalassemia and GI cancers. There is no visible blood in stools. I have been advised to do an iron trial. If no change in MCV or MCH after the trial, likely I have a thalassemia trait or carrier. Also, I have been fairly active with running and sports over the last three years, with moderate intensity training four times a week, including a run average of three miles three times a week. I sweat a lot. Could my low normal ferritin be secondary to that? Is there an indication to do a colonoscopy with my current laboratory results, as recommended by the doctor? I want advice and a second opinion. Thanks.
Hi,
Welcome to icliniq.com.
I understand your concern.
All your report (attachments are hidden to protect the patient's identity) values seem within the normal reference range. Your hemoglobin value is also within the limit. As RBC (red blood cell) mass is slightly high as per history, thalassemia can be ruled out by high-performance liquid chromatography testing (HPLC). It is a gold standard test for ruling out hemoglobinopathy. MCV (mean corpuscular volume) value is also not much low. Hence if you have no symptoms, then no active intervention is needed. If you have gastrointestinal problems or if iron deficiency anemia is present, then a colonoscopy is needed. Otherwise, in healthy individuals without any symptoms, no colonoscopy is needed.
Hope your concern is solved.
If you have any clinical complaints, then provide them for giving more comments with attached reports.
Take care.
Patient's Query
Hello doctor,
Thanks for your advice. The only thing that bothers me is the serum ferritin which is just above the cut-off range. Do I need to follow it periodically? Or do you think that it is fine to have ferritin in this range as long as I do not develop anemia? Would you recommend taking iron supplements?
Hi,
Welcome back to icliniq.com.
I understand your query and concern.
Your serum ferritin value is within the range. Hence do not worry about that. It is just above the cut-off range, but do not worry about that, as serum ferritin reflects the storage form of iron within the body. An iron supplement is not needed here because you are totally asymptomatic, and your hemoglobin value is within the limit. You can consume iron-rich foods like jaggery, dried fruits, green leafy vegetables like spinach, meat, etc. Take a healthy and balanced diet and less junk food. You can check your CBC report after a few days.
Hope your concern is solved.
Let me know if you have further queries.
Take care.
Patient's Query
Hello doctor,
Thanks again. I wanted to follow up on my case. I was advised by a GI doctor to do stool for occult blood just to be on the safe side due to the low ferritin. I did those at home, but I got confusing results on a few. I do not get a blue reaction in the stool in the first minute, but after a minute, I get a little blue-gray-like line outside the smear edge (more like a double edge). I am not sure if that is positive or not. I have attached the picture for your review.
Hi,
Welcome back to icliniq.com.
I understand your query.
I cannot find any attachments here. If you want to post an image, then kindly upload it again. Usually, occult blood benzidine tests are done in which hemoglobin, if present in stool, has peroxidase activity and released oxygen molecule oxidizes benzidine to produce green or blue colored reaction product. Color develops within five minutes and can be considered positive. But kindly read manufacturer instructions, and according to the literature provided in the kit, do your occult blood testing. If it seems difficult for you to perform testing, then a nearby pathology laboratory can be searched, and their trained pathologist will do testing for it.
Hope your concern is solved.
Take care.
Patient's Query
Hello doctor,
Thanks. See the attached reports.
Hi,
Welcome back to icliniq.com.
I have seen the attached image in the report (attachments are hidden to protect the patient's identity).
In my opinion, your test for occult blood seems to be negative because I cannot find a green or blue color like that provided in the positive control below. Still, I suggest you read the kit insert also for the interpretation of the test. If you have no gastrointestinal symptoms, then I am not in favor of doing further testing. Take a good diet with more green leafy vegetables and fruits.
Take care.
Hope this will help you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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