Can anyone tell me if I should be worried about these numbers? Her doctor says this is ok.
WBC 7.7 4.1-8.9
RBC 4.05 (low) 4.10-5.20
HGB 13.2 12.2-14.8
HCT 37.7 36.3-43.4
MCV 93.2 (high) 80.0-92.3
MCH 32.5 27.0-34.0
MCHC 34.9 32.0-36.0
RDW 12.9 9.0-14.5
Neutrophils 65.4 (high)- 35.0-65.0
Ferritin 23.57 - 13-150

She has been fatigued for a while now and just lately has had a few woozy spells. She eats a really healthy diet so that's not it. I have had her on a good vitamin regimin with added iron supplement for the last two months - as her ferritin seemed low on a thyroid test we had done. That number hasn't gone up with the supplementation. By the way - the thyroid test showed TSH at 1.2 (.3-4.2) and Free T4 at.97 (.93-1,7)

Thanks for any help you can give me!

While her ferritin is on the low side of normal, it is not abnormal.

There is no indication that she has anemia and certainly not iron deficiency anemia because her MCV is high. The MCV is the measurement of the red blood cell. In iron deficiency anemia, the MCV will be close to the 80 or far below it. Long-term iron deficiency anemia will cause very small red blood cells. Hers seem to be large.

The neutrophils are on the high side which indicates either a recent infection or some type of ongoing inflammation. My neutrophils have been elevated for well over a year and no one seems to care or will tell me why.

Anyway, it doesn't appear to be an iron deficiency anemia here.

Thanks ChristineVA - I appreciate your response
Should I stop the iron supplement?

I don't know if it would be necessary to stop the iron supplement. It wouldn't hurt if her ferritin were higher (I think ideally they like it to be at about 70). So, I don't think that the iron could be "hurting" her if you know what I mean. Is she getting any side effects from the supplements? If they are making her miserable, you might want to stop it, but if not, having just a simple iron containing multi-vitamin could be enough for her.

These look like the normal results of a young girl, probably not taking a multi-vitamin containing elemental iron, and might be having heavy periods. You can choose to put her on birth control pills to lighten up her periods and have her take a good multivitamin containing iron on a daily basis. She is probably fine.

Actually - she is taking a really good multivitamin with elemental iron plus extra liquid herbal iron she adds to her orange juice. She didn't start her period at all until last month (yes -at 16 1/2 years old!) I put her on the supplementation after getting a ferritin test back that was at 20. This is a girl that is very health conscious, eats good, healthy food and is still having a hard time with fatigue. I just kinda wonder what her numbers would have looked like without the major supplementation. Just a fretting mom - I worry about the ferritin because it was a major issue for me to get my ferritin up with thyroid problems and I know how much difference it can make! I just don't know if I'm worrying too much...

I noticed that your daughter's MCV, mean corpuscular volume, is elevated. It is an important marker in hematology and the diagnosis of anemia. The range signifies low = microcytic anemia (usually iron-related) and macrocytic (b-12 related). While your daughter's MCV elevation is not at the clinical level for pernicious anemia (b12), I would urge you to have her serum b12 measured.

The newest markers which are supposedly even better than serum b12 for measuring deficiency are elevated homocysteine and MMA (Methylmalonic acid). You can find refs to these on e-medicine or web MD as new standard labs.

I do stress that the labs do not point to clinical deficiency, but may indicate low levels, which in my experience can have a profound effect on one's quality of life.

Here follows my own experience living life at the subclinical level of low iron, b-12 and thyroid stimulating hormone:

I sympathize with you and your daughter. I suffered from unexplained fatigue for years and drs all thought it was imaginary - especially since I was supposed to be a young, healthy woman. I learned a hard lesson - that one need not be clinical to suffer debilitating symptoms from low iron, b12 and low thyroid.

My symptoms, such as fatigue, loss or hair, dizziness, lack of focus, low blood pressure, cold all the time and more, increased over time, but I continued to fight against them believing as my drs seemed to indicate, that it was all a condition of life and that none of the symptoms were related.

It was not until 2006 when I could no longer take the significant anxiety and panic attacks which began in 1994, that I ended up on the road to recovery. It seems my subclinical hypothyroidism (looking back at records) became overt. Looking at my old records, I see now I was already in the 4.0 range in 1995, but nothing was done about it. I ended up at 6.0 tsh in 2006.

Stupidly, and with much regret, over the years I never actually examined my bloodwork results and left it to the interpretation of drs. BAD IDEA. So, it is good you are being proactive with interpreting your daughter's cbc.

I began treatment for hypothyroidism last April, the anxiety subsided and I felt a lot more clear-minded and could concentrate better, but fatigue still continued even after treatment with thyroid hormone and is very bad.

While researching on thyroid conditions, I came to see a lot of people also had iron and B12 concerns, So, I decided to be proactive with my health care and decided to investigate my iron and b12 levels.

I decided to ask my dr. for a serum b12 test and it came back in the 200's. I now understand that one should be above 500 even though current lab ranges, and "old-school" drs don't necessarily see it that way. But, if you search the medical literature, there is a growing consensus that the lower limit of serum b12 should be higher than what it currently is.

I have been taking a b12 supplement for about a month, and feel a bit better, though the brain fog still persists and the fatigue following exercise is still profound.

With regard to my iron levels, I saw that I had a serum ferritin of 18. From reading posts on this board, and searching the literature, there is some evidence that the level should be higher. I have seen from 30 - 70. I decided to supplement with iron - in my case ferrous sulphate 325 (65mg elemental iron). I have been doing so for a few weeks.

My advice:

1. Continue to supplement with iron with or without dr guidance . I would be conservative here and say that your daughter should supplement with the standard dose for pre-menopausal women, 18 mg/day [according to Office of Dietary Supplements • NIH Clinical Center • National Institutes of Health] I would however, test regularly and eventually seek out a drs supervision for this if you want to try to achieve a higher serum ferritin level in the event the conservative supplementation does not elevate it more than currently.

2. Seek further tests related to b12 as specified above and supplement if it is below 500. With b12 I have been told that there is little danger of too much as the body excretes the excess. You really do not need to do this under a drs supervision. I prefer a sublingual preparation, after researching that it is more effective than pill form.

3. Continue to research medical literature and other materials on the internet to increase your certainty about treatment choices you and your daughter will make.

4. Seek out a practice that emphasizes "integrative medicine" and will approach fatigue from a nutritional, hormonal or autoimmune standpoint.


Best of luck!

Thanks for your detailed response. It was uncanny how your experience nearly mirrored my own... I have come to the conclusion after many years of dealing with thyroid and low ferritin - that doctors are tools, and you have to know what to ask and how to use the information you get from them. I aggressively follow up on all tests and learn everything I can. The one thing you mentioned was the level of B12, which I had checked on my daughter several months ago. I'm going to dig up that test and see what that level was. Thanks again for sharing your wealth of information - it's just really nice to hear that what we do (not always giving doctors God status) does not make us the crazy ones!

You are welcome. That is why I spent so much time responding. I am now 40 and I feel like half my life has been wasted - I could have done so much more if only I was properly treated, but instead I spent a great deal of that time trying to deal with the fatigue, especially. In my late teens, I began to feel fatigued, and my hair began to thin. I was told to be more active and that I had "male pattern baldness". It was all down hill from there. By my late twenties, the panic attacks began. I was told I needed to learn how to manage my stress. Now, I see that there was a clear biological basis for everything and I wasn't imagining things!

I am glad now that I am in control of my health and no longer rely on the whimsy of uninformed or disinterested physicians. You daughter is lucky to have you advocating for her. Again, best of luck!

Hi.
If she has any symptoms like canker sores, itching skin, stomach issues, intestinal issues, etc. I would get her tested for Celiac disease. I lived my whole life until a year ago not knowing I had it. Anxiety attacks, digestive disturbances, etc., anemia, fatigue, etc. I'm much better now that I've gone gluten free.

Just thought I'd mention it, in case it made sense to you.

She doesn't have any of those symptoms - but it's good advice to look out for. I've read a little about Celiac and I hope you're feeling much better now. Thanks for the input