A long story short, I have had very mild anemia (HB between 110-140, HCT between .36-.40, RBC between 3.6 - 4.5) for the last 4 months. With this, the more serious point has been my retic count has been low, pointing signs to my bone marrow not producing. In my most recent test, all my red blood cell counts were up a bit and at the bottom of each normal category. With this same test, my absolute retic count was 15 (ref range 25-90). My GP was concerned as I have been anemic for many months and now my bone marrow retic count is showing low. She relayed the message to my hematologist. My hematologist told my GP that she feels this isn't bone marrow related and I should see a GI specialist because my anemia has been on and off. I was dehydrated that day, I have had 6 cbc's in the last 4 months and only that one was normal, and it was just barely. I did another CBC 2 days later and I was anemic again. The thing is...I did a FOBT test 3 weeks ago and it was negative. They are sending me anyways. I am scared to go off of the bone marrow path, as the retic test is for bone marrow! My hematologist said it is normal sometimes for retic to be low after anemia is corrected. My GP did not agree, but had no choice but to listen and send me to a GI doctor first.
My question is...is it possible something is wrong with my GI even with a FOBT is negative? I have had stomach problems such as loose stool, stomach pains, gas my whole life but never thought much of it. Lately I have had some pains in my upper abdomin, but it is nother severe and I always attributed it to working out. Any help is appreciated!
Normal hgb is 14-18g and hct 38-54% for males, there are many other cells involve with bone marrow activity. Usually when you see a hematologist, they look at the cells through a microscope and examine all the cells, if they thought there was a problem with bone marrow not functioning they would do a bone marrow aspiration for an extensive look at the actual bone marrow cells being produced. Are you taking anything for anemia? Also one fobt is not sufficient to r/o a GI bleed.
Thanks for your reply. No medication for the anemia as my levels have not been low enough. Ranged between:
HB- 11.0 - 14.0
HCT - 36% - 40%
RBC - 3.5 - 4.5
Also over the last year my WBC has gone from 7-9 to 4-5, Lymphocytes from 2 to 1.2 (low) and my platelets have gone from 250 down to 160-180. Although with all this, the dr's find my anemia mild and are not concerned with my other drops. To me it is concerned because something has to be there for them to drop slowly over a years time. Also, my iron, b12 and folic acid are fine, so this can not fix it. Basically because my anemia ranges from mild to borderline normal, the hematologist feels it can't be bone marrow. The way my GP sees it is, I did a retic test to check my bone marrow, it came back low, that means the bone marrow should be checked. I feel the same way, but the hematolgist wont see me until I see a GI specialist. I don;t understand how this could be a GI problem just because the anemia goes up and down each test.
One negative FOBT doesn't count out GI bleeds, but my doctors want me to do a full scope to look inside. I'm ok with it, but I have a negative FOBT, wouldn't I need a positive FOBT before they look inside with a scope? I just agree with my doctor, the marrow should be looked at first. Any experience or advice helps.
Just my opinion, but I think if it was me and the anemia is mild and if you feel ok, I would not go through the whole GI workup unless the anemia worsens or like you said positive fobt. It is usually standard to check out the most obvious things first that is why the GI route.
There are several GI malabsorption syndromes can cause anemia with low retic count. Have you had any blood tests for inflammation? (ESR or SED rate, CRP/C-reactive Protein) Or a CMP, complete metabolic panel?
Since you've had GI problems for a long time, I'd suggest you see the gastroenterologist . . . but if you're really worried and want to put your mind at ease, go ahead and call the hematologist, make the appt, they won't turn you away. Hematologist/Oncologists offices' are usually pretty understanding about that sort of thing.
Last edited by AuntieLeela; 10-25-2009 at 08:04 PM.
I have been tested for all those you mentioned and everything came back normal. That is the strange part, I've been tested, yet the hematologist still believes it is more likely GI related.
I am still seeing the Hematologist in December, basically she just doesn't want to spend time until the GI part is cleared. If GI is clear, then she will look into it. I just hate waiting as my GP has told me how serious it can be to wait. Oh well, not much I can do. Thanks.