Low ABS Retic, low normal RBC

[Tohobo]

Hi,

Over the last 6 months I've been having blood work taken to check my reticulocyte count. Over these tests, my absolute reticulocyte count has always been quite low and my RBC/HB/HCT have always been mildly low or borderline normal. Here is my latest lab test below. My question is why is my absolute retic count so low if my RBC is normal? I would like a BMB, but I doubt my doctor will go for it until my RBC goes lower.

Thanks a lot!!

ABS Retic: 13 (range 25 - 85)

RBC: 4.4 (ref range 4.4 - 5.6)
Hemoglobin (HGB): 135 (range 130 - 170)
Hematocrit (HCT): 38.5 (range 39 - 50)
PLT: 190 (range 140-400)

WBC: 4.9 (range 4.5 - 11)
ABS Neutrophils: 3.50 (ref range 2.0 - 6.3)
ABS Lymphocytes: 0.90 (ref range 1.5 - 3.5)
ABS Monocytes: 0.30 (ref range 0.2 - 0.8)
ABS Eosinophils: 0.15 (ref range 0.04 - 0.4)
ABS Basophils: 0.05 (ref range 0.00 - 0.1)

B12: 276 (range 220 - 1000)
Ferritin: 65 (range 50-80=reduced, >80=normal)

[Marlene]

I would address your B12 and Iron levels to bring them up to a mid-normal range instead of a low normal range.

A B12 level of 276 is low enough to cause problems and should be addressed. Are you a vegetarian? Or do you have digestive issues which can impair the absorption of nutrients from your food. Many doctors do not keep current on the latest nutritional recommendations. Many European and Japanese doctors have a higher lower range of 500. If you read through this B12 paper, you'll see that 50% of those with low normal B12 are actually B12 deficient and that the B12 serum test currently done, missed them.

http://www.aafp.org/afp/2003/0301/p979.html

You may want to have your copper, zinc, folate and B6 tested also. If your low in iron and B12, there a good chance you could be low in others. There are optimal ranges for nutrients.

B12 is easy to replace orally with sub-lingual tablets. There are a few forms of B12 and the most common is the cyno form. That form needs to be converted into a usable form. So, it's best to use the "methly" form of B12.

I would address the nutrients before undergoing a BMB.

[Tohobo]

Thanks for the quick response.

Good guess Marlene...I actually have Celiac Disease. Although I have been gluten free for 15 months and my albumin is high, which my GI doctor says is a good sign I'm absorbing nutrients again. Also no vegetarian here...big meat eater. I'm athlete, so I eat a high protein diet of lean meats/fish.

Currently here are the vitamins I've beed tested for:

Copper: Never tested
B6: Awaiting results

Folate: 10 (normal 3 - 16)
Vitamin A: 138 (normal 50 - 200)

Zinc: 15 (normal 15 - 30)
Vitamin D: 30 (normal 30 - 60)
INR: 1.25 (normal 0.8 - 1.2) <-- shows slightly low in vitamin K
IRON: 65 (30 - 300)

My doctor said my zinc and vitamin D were only slightly low, so it is no big deal and wont see any symptoms for it. As for my INR (vitamin K), once again, only slightly low. Iron is considered optimal at 70-90 he said, so mine is pretty good. The rest were normal or not completed yet. As for B12, my doctor said 276 would not leave me with any symptoms and there is no need for anything to be done. I've been taking sublinguals for the last year, but wont go up.

Thanks for the tip Marlene, I appreciate it. Do you know why the vitamins would affect my retic? My RBC is pretty normal, just retic is always so low.

Thanks.

[Marlene]

Oh....Celiac Disease. IMO, your B12 is low and I would try to be more aggressive in bumping it up. I've met too many people with low-normal B12 who were told the same thing only to find that B12 really helped them. Depending on the form of B12 you are taking, you may not have what you need to convert it to a usable form. Also, if there's an imbalance of bacteria in your gut, the bad stuff will eat up the B12. When taking B12 orally, especially in your case, you need to take a high dose in order for some to get absorbed. There are/is a liquid spray that doesn't have to go through the gut that may be helpful for you.

On the vitamin D....a low normal is not optimal. Spend some time reading about vitamin D at http://www.vitamindcouncil.org/

With zinc....there's a relationship with copper and you doc should check the zinc to copper ratio. If you search on copper in this site, there's a couple of threads on this topic.

Apparently your body is able to maintain those blood counts with a lower retic. B12, folate, b6, copper, iron are needed to make blood. B12 is critical to nerve and mental health also. It can take years for symptoms to show up when someone has low, low-normal B12.

[Tohobo]

Thanks again Marlene.

In case it has anything to do with the situation, I also just had an ultrasound come back and my spleen is mildly enlarged at 14cm x 5.5cm x 4.5cm. My last ultrasound was in July of 2010 and my spleen was 10cm x 5.0cm x 4.3cm. Any idea why a spleen would get enlarged...should I have my doctor run another CBC with retic?

Thanks again.

[Marlene]

Can't help you on this one....no experience with the spleen. There are others who more knowledgeable on this subject and may comment.

I'm sure your body has a lot to correct from the celiac and that will take time.

[Greg H]

Hey Tohobo!

I think Marlene gives you good advice that those bottom of normal counts are well worth working on. But, as she says, it may take a while for the numbers to build back up, given your celiac problem. My wife can't absorb B12 through her digestive system, and so takes twice monthly B12 injections.

Beyond that, the enlarged spleen is a bit concerning, since there are a number of conditions linked to that, including some hematologic problems. Here's a pretty basic starting point from the US National Institutes of Health.

I'd definitely encourage you to have your copper levels checked. I have low copper, as do a number of other folks on marrowforums, and it is an often overlooked problem that can mimic MDS, causing significant anemia, and can also lead to neurological problems.

Are you working with a hematologist at this point?

Take Care!

Greg

[Tohobo]

Hi Marlene/Greg, thank you both, you have eased my mind a bit by just talking to others.

As far as the B12, I will keep on that. As far as the copper, I will ask to have it checked. THanks!

I am not currently working with a hematologist, I saw one back originally when my retic was first low but she dismissed my family doctors concerns because my RBC/HB/HCT were all just borderline low and not extremely low like my retic would presume. Since then I've continued to have low retic and RBC/HB/HCT is borderline low as of November 2010. My spleen size was 10 cm at the time of seeing the hematologist and is 14cm now.

I posted on here because I'm not sure if i should schedule an appointment with my family doctor to see a hematologist again or should I just ignore the spleen?

Thanks.

[Chirley]

Hi,

My spleen is also enlarged. My doc said not to worry, he'll just "keep an eye on it". He said that in utero the spleen and liver produce red cells and when we become chronically anaemic sometimes they try to produce red cells again and this causes them to enlarge in some people.

This may not be the story in your case and it's best for your doctor to determine if it's significant.

Regards.

[Tohobo]

thanks for the information, it is appreciated.

The problem is my CBC has not changed, just borderline low...barely low...more like low normal most of the time. With the 4cm increase in spleen size, nothing really changed on my last CBC. So I don't know what is the reason. My doctor will likely take the same approach to monitor. I see her on the 18th, so I hope to get at least blood work ordered.

Thanks again.

[Marlene]

Thanks for that reminder about the liver and spleen making blood. I completely forgot. Funny, how I forget so much of the stuff I researched when John was critical now that he's doing so well. In infants, the liver makes blood until the bone marrow kicks in.

Tohobo....Do stay on top of things and do everything you can to improve your overall health. Nutrition is an important aspect of healing. John's HGB and platelets were always low normal and sometimes just below normal. They too told us that it must be normal for him. As far as we know, he was like that for at least 20 years before he came down with SAA. But try not to obsess about it. Focus on getting your nutritional status up. It takes time to restore, and then time to heal. You've already taken a huge step to stopping the progression of injuries due to gluten and that is significant.