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Old 09-25-2009, 02:15 PM   #1
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why am I being sent to a hematologist?

Hello All,
I hope someone can give me their opinion on this. I am 61 yrs. old, in good shape, not on any medications at all except 81 mg of aspirin. My latest CBC test came back showing 3.1 RBC and 3.0 WBC and an "abnormal" level of transferrin of 264 whatever that means. My ferritin level was 12.7...also low.
My internist has referred me to a hematologist whom he said will probably do a bone marrow aspiration. I asked if this was not overkill...why not just have me take iron? The doctor said they want to find out exactly what is causing the low counts. I still think this is overkill, does anyone else? I really do not want the biopsy, but of course will trust the judgment of the doctor. thanks for any help.

 
Old 09-25-2009, 02:29 PM   #2
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Re: why am I being sent to a hematologist?

What are the results of your complete blood count and differential counts? Your doctor should provide them to you. They would probably reflect any abnormalities in your circulating blood cells that would indicate a hematologist and/or a biopsy.

Last edited by ocelot; 09-25-2009 at 02:57 PM.

 
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Old 09-25-2009, 03:09 PM   #3
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Re: why am I being sent to a hematologist?

thank you, ocelot, but I don't know what is meant by my "differential counts"? I do have the results in front of me. Hemoglobin, 10.9, HCT, 32. MCH is 31. I am sorry to be vague, I did ask him why I can't just take iron if that is what is low and he said the hematologist will determine why it's low. I read of others taking iron...

 
Old 09-26-2009, 09:30 PM   #4
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Re: why am I being sent to a hematologist?

Nutmeg,

The differential count is a breakout of the numbers and percentages of the different kinds of white blood cells or other cells found in your blood, and would refer to things like MONO, LEUK, LYMP, EOS and BAS. These counts are usually included with a thorough blood workup but aren't always ordered.

Do you have any results for MCV (mean corpuscular (red cell) volume), MCHC, PLAT or RDW? They would help to characterize any potential anemia or other cytopenia they might be concerned about.

I'm not a doctor but think the numbers of your WBC (white blood cells) and RBC (red blood cells) are low. It would be interesting to know whether your platelets (PLAT) are low too. These findings can be spurious or could be caused by any number of conditions and I'm sure the first thing the hematologist would do would be to run a full set of tests covering a variety of measures including rerunning those the results of which you already have. If you have low numbers of white and red cells then it is possible that any potential problems might not be limited to iron deficiency issues that would respond to iron pills, and hence the referral to the hematologist for a further workup.

It is easy to say, but don't let all of this worry you, just go to the hematologist, take along a detailed list of any questions you have and be sure to make sure you get answers that you understand. They probably wouldn't decide for sure on whether to do an aspiration or biopsy until they do a month or two of bloodwork to see what the course of things may be. I have been through a similar process and have a few increasing abnormalities in my bloodwork. My red cells are too few and too big and getting bigger and fewer, and my platelets are too small and dropping in number (but the number is normal for now). I will probably have a marrow aspiration and biopsy done by the end of the year (but am trying to enjoy the state of denial for the moment).

In my case, we think we have eliminated just about any condition from the differential diagnosis except myelodysplastic syndrome, which is a diagnosis that can only be made based on biopsy results. It is something they would probably consider in your case, as based on the results you've mentioned, you have low counts in at least two of the three blood cell lines (white cells, red cells and platelets), but you may have normalized or had a response to some kind of treatment that would eliminate it as a concern by now.

Best of luck, and just try to stay as informed as possible. Get a second opinion if you have any question about anything they tell you.

Last edited by ocelot; 09-26-2009 at 09:31 PM.

 
Old 09-27-2009, 06:00 AM   #5
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Re: why am I being sent to a hematologist?

Ocelot, first of all, I wish you all the best and will keep good thoughts about you. Thank you so much for your very lucid description of what may or may not be happening with me! I truly appreciate you taking the time to explain what the tests may mean. You have explained things to me far better than my own doctor explained things, but perhaps I did not ask him enough questions as I was taken aback by his referral.
I am encouraged to read that the hematologist probably will begin by either re-doing the bloodwork and/or doing more extensive bloodwork before deciding to do an aspiration! That makes more sense to me.
I really want to thank you again for your help and I wish you all the best.
nutmeg

 
Old 09-27-2009, 06:14 AM   #6
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Re: why am I being sent to a hematologist?

Ocelot, my differential count all came back in the normal range. The platelet count also came back normal. Only the MCH came back high...35.3. Can you tell from this what MIGHT be going on? I know you say you are not a doctor! thank you for any comments.
nutmeg

 
Old 09-28-2009, 02:02 PM   #7
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Re: why am I being sent to a hematologist?

I noted that in your earlier post you said the MCH was 31, but in the last on you say it was 35.3. 31 is a normal result for women by most standards.

There are many things that can cause the kinds of results you have, including simply normal variation (statistically, at any time there is a 5% chance a healthy person will show an abnormal result on a given test).

Medications, internal bleeding, autoimmune diseases, thyroid problems and certain infections all would have to be ruled out before addressing bone marrow issues.

As mentioned, best thing is to write all of your questions down in advance and make sure you get understandable answers to all of them before you leave the hemtologist's office.

Best of luck.

Last edited by ocelot; 09-28-2009 at 02:02 PM.

 
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