Is low B12 with high hemoglobin and hematocrit polycythemia?

Question

Hello doctor,

Last week I went to the doctor for several reasons, like headache, weakness, tightness and pressure in the head, and body pain. He ordered some blood work and a chest X-ray. The doctor told me that the chest X-ray report is good, and he just told me I have a low vitamin B12 level and I have bacteria in my stomach.

He prescribed me Omeprazole, Clarithromycin, and Amoxicillin, and I took five shots of vitamin B12. But still, I feel tightness in the head and several headaches. My hemoglobin and hematocrit levels are too high. My bowel habits have also changed. I pass stools right after eating three to four times a day.

All my symptoms point to cancer.

Do you think I have polycythemia or polycythemia vera?
Do you want me to consult hematologists?

Please give your opinion.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your history and reports (attachment removed to protect patient identity).

You had a complaint of left-sided abdominal pain with a headache. Hence, gastritis can be a possibility, and for that, antibiotics and antacid courses are prescribed.

Sometimes the upper gastrointestinal infection can lead to poor absorption of vitamin B12, and so deficiency can occur, but here your B12 value is borderline in the report. So further workup can be done at that time by measuring homocysteine and methylmalonic acid to confirm B12 deficiency.

Anyhow, you completed the course of B12 injection, so no need for measurement of homocysteine. Your stool frequency is increased, and it seems to be stress-related irritable bowel syndrome (stress and anxiety lead to headaches as well).

Yoga, meditation, and exercise will be beneficial in reducing stress. Consume more fruits and green leafy vegetables.

If needed, psychiatric help can be taken. If stress and anxiety are not related, then a USG (ultrasound) abdomen or an endoscopy-like workup can be planned only if gastrointestinal symptoms worsen.

In your attached CBC report, the values are within limits. In polycythemia (which you are suspecting) Hb is greater than 17.5, WBC count and platelets also can be high, RBC values are high, and HCT is more than 55% usually. So here, polycythemia is not a possibility.

Repeat CBC after completing your antibiotic course. Lack of sleep, hypoglycemia, smoking, stress, irregular meal habits, migraine, etc., are some other causes of headache.

I hope this helps.

Thank you.