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Forum Name: Hematology Topics

Question: hi wbc, rbc, cRp and Hi Plasma Viscosity


 whitbywitchuk - Fri Dec 26, 2008 12:18 pm

Hiya
My health has deteriorated over many years. I am now 48 and have Hashimotos an autoimmune thyroid disease which eventually took me into hypothyroidism. I was treated a long time with T4 however 3 years ago I was having attacks of total prostration where I found it too hard to move my diaphram to breath many times a week. I suffer from aches and pains all over and cannot brush my hair without my arm getting weaker and weaker. I have got more and more short of breath over time and inhalers make not much difference to this. I have or had every symptoms of hypothyroidism left even though on treatment so I started myself on Armour thyroid which improves things quite a bit, however I still had problems raising the Armour to a decent dose to eliminate my symptoms. A saliva test confirmed me as low cortisol and I now take hydrocortisone every day too. My breathing is slightly better the more hydrocortisone I take, and the aches and pains and flulike feelings are a lot better. However I am far from well.
I have a GP who is running on a low budget and tests and time with him are very small so I have never really been effectively investigated.
I went to see him last week and told him I had now developed vitiligo and showed it to him, he confirmed I had, he also was unaware of my autoimmune state with the thyroid even though it was tested 18 months ago and came back positive. He ran these tests below, the results I find worrying and don't know what to ask of him from now on as he doesn't seem to know where to look for my underlying condition. My high WBC cound has been getting higher over 4 years and each time they say I must be fighting a cold or something, but this cannot be so for all that time. Each time I have it taken there is no sign of a virus. I expect high CRP with hypothyroidism but not all the other things which are high alongside it which makes it more worrying. Do I need iron pills? How are the MCV and RBC relevent? Do the test mean I have low blood volume and all the pains and shortness of breath are associated with the plasma viscosity? What about the creatinine which has been high on tests for a long time?
It seems the doctor just says everything is ok and every time I have a test something else turns up as my health gets worse and nobody seems to have a clue as to where to look or what to do? Could you please explain what my tests indicate and help me find some kind of questions to ask the docotor?
I thank you in advance and here are my test results....

Blood results from 18/12/08


Serum FT3 5.3 pmol/L (3.0-6.1)
Serum FT4 12.5 (10.0-24.0)
TSH 1.39 (0.300-5.000)

Plasma viscosity HI 1.76 mpas (1.50-1.72)

HB 15.0 gDL (11.5-16.5)
MCV 84 fL (80-100)
Platelet Ct 344 10*9/L (150-450)
Total White B Ct HI 11.40 10*9/L ( 4.00-11.00)
Neutrophil Ct 6.20 10*9/L (2.00-8.00)
Lymphocyte Ct 4.00 10*9/L (1.00-4.50)
Monocyte Ct 0.6 10*9/L (0.2-0.8)
Eosinophil CT 0.50 10 *9/L (.00-.1.00)
Basophil Ct 0.10 10*9/L (0.00-1.00)
LUC 0.20 10*9/L (0.00-0.70)
Packed cell volume .434 L/L (0.360-0.450)
MCH 28.9 pg (27.0-32.0)
RBCs HI 5.19 10*12/L (3.90-5.00)

Serum Sodium 140 mmol/L (136-145)
Serum Potassium 4.3 '' (3.5-5.1)
Serum Urea level 5.4 '' (2.8-7.6)
Serum Creatinine HI 81 umol/L (44-80)

Serum glucose 4.5mmol/L US 81

Serum Plasma Proteins
Serum total Protein 73 g/L (63-79)
Serum albumin 43 g/L (38-47)
Serum globulin 30 g/L (18-32)

Alk Phos 95 iu/L (32-104)

Serum tot bilirubin lvl 10 umol/l (<16)

ALT/SGPT serum lvl 27 iu/\L (10-36)

Plasma C ReAc Prot HI 15mg/L (<6.00)

kindest regards
Whitters
 John Kenyon, CNA - Sat Jan 17, 2009 12:11 am

User avatar Hi Whitters -

I didn't have too much trouble finding your post. The problem will be sorting out the results here and correlating them with your symptoms. I definitely believe the slightly elevated red and white count correlates with the slightly high plasma viscosity, and overall probably would correspond with volume depletion due to mild dehydration. Why that would be is difficult to say. Perhaps you simply don't take in sufficient fluids?

As for the symptoms, these do match up well with low cortisol levels, but you need to have a stimulation ("stim") test to come up with a true and workable level in order to know if there is a problem and what it might be and how to treat it. Both the increased (but unregulated) thyroxin and hydrocortisone self-treatment are suggestive, at least, that there's something there that needs a closer look.

If there is any way you can either get more service from your doctor or find one who is willing to do more thorough investigation, it would be a huge help. I think you've got enough insight into the problems to recognize the connections between these issues, but you'll need far more precise test results and dosing in order to get this all in order.

The increased CRP is probably indicative of a low level of systemic inflammation which may be reasonable for someone with autoimmune problems. It probably correlates well with Hashimoto's and perhaps some other inflammatory problems.

While I think you're probably on the right track here, and while the symptoms are no doubt unacceptable, at least you're working toward something of a resolution. Unfortunately you require expert and thorough medical help to get this all diagnosed and managed properly. You've done about as much as anyone can without a more thorough medical partner. Your blood work is generally fine, but the parts you cite do suggest the things you've already mentioned, and your self-medication, while not something we'd normally encourage, do seem to bear out, at least on the face of it, your suspicions. Now you need to have this confirmed properly and treated precisely.

I would also look at the possibility of something causing mild to moderate dehydration, as that is the likely cause of the plasma viscosity and relative (though minor) "off" readings on RBCs, WBCs, etc. The CRP can probably be brought down some by anti-inflammatory medication, but I wouldn't try and make that a do-it-yourself project, as it is potentially risky to go that route. Hopefully you can either get more out of your doctor or find another doctor who is willing to do more of what's needed.

I certainly hope this is hellpful to you. Best of luck and please do follow up with us as needed.
 whitbywitchuk - Sat Jan 17, 2009 9:16 am

Hi John

Thankyou so much, you have no idea how much I appreciate your help. I think you are absolutely right about the need for a doctor who is more hands on and not just sitting back while I try my hardest to get well without hardly any input or help from him. I am between a rock and a hard place as I cannot travel far, live in a very small town in Northern England with just one Drs practice (quite a few Drs in it) in the whole town. I worry if I upset this Dr the others will wash their hands of me. I will try moving to another Dr in the practice to see if that helps at all though. I think he thinks I am just a hypochondriac you know...wibble lol. He said I needed to see a private Dr for some reason, if a private Dr could help, why can he not?

The dehydration, I have no idea how that could be, I drink lots of fluids throughout the day but on some of the thyroid forums like TPA-UK and STTM yahoo groups the other suffers seem to associate hypothyroidism with dehydration and also CFS of course is closely associated with low blood volume too. I see a connection with the CFS and the endocrine system more than is publicised I think.
I shall conciously try and drink water throughout the day in an organised way to make sure I am getting the fluids for sure. My urine is very concentrated this week for some reason too and I don't think I have an infection, so that would suggest what you say also with regard to the dehydration is correct too.

Lots of the symptoms went when I started Armour, more went when I started HC. but I am left chiefly with cramps in ribs around back and under breast, with weak muscles and inability to support my upper body for long enough to walk around a while. Hypermobile joints. The most troublesome symptoms is puffing and panting shortness of breath on even the slightest exertion even with clear chest and open airways, wierd.

The only thing I am doing in connection with inflammation is taking Serrapeptase as it is prescribed in Europe for this purpose but is not a pharmaceutical which of course I wouldn't try to put into my treatment for fear of interractions. Any more strong drugs would possibly kill me off. I am wondering if any of the ones I am on from the Drs are causing any problems like the Seroxat(Paxil), Diazepam, Olmasarten.

Anyway I hope if you are anyone else has any more thoughts or help you will post again.

Lovely to meet you here John
Good health to you.
God bless
Whittersx
 John Kenyon, CNA - Sun Jan 18, 2009 12:15 am

User avatar You're very welcome, and lovely meeting you here as well. I only wish I were able to offer you something more substantial by way of direction. What you've come up with makes sense as far as it goes. The comment by your doctor that a private doctor might be better suited is certainly strange. It may well be another doctor in the local practice might be a better "fit" for you. It's probably worth a trial at least.

The concentrated urine certainly does argue in favor of dehydration. The reason isn't clear, but your plan to purposefully take in more fluids should at least help with this.

The muscle cramping and weakness suggest a neuromuscular problem, whether secondary to one of the other disorders which may be present or in some primary form. Again, it's difficult to tell from this distance. Hopefully a different doctor may see something the current one hasn't.

Please stay in touch with us here and keep us updated. Good luck and good health to you.
 whitbywitchuk - Sun Jan 18, 2009 1:06 pm

I certainly will keep in touch.
I think I will try another doc in the practice, probably cannot be any worse.
I am going to ask to see a neurologist, at least if he cannot do anything he may refer me to someone who can. The NHS are now clamping down on referrals and you can tell from my GPs attitude.
Thankyou very much John
lotsa luv and good wishes
Whitters Dawnx
 whitbywitchuk - Mon Jan 19, 2009 1:35 pm

HIya
Just to let you know, my doctor rang in response to my call and he loves the results of my blood tests. He thinks the HPV is going to together with the CRP inflammation and the RBC are higher because I smoke. I mentioned my urine and he is going to do a urine test. Ah well, at least it is slight investigation. I am sure that I need deeper investigations though as you said John. He never mentioned investigating causes of dehydration as he doesn't think that is the cause.
I had to laugh at the wonder in his voice that my Armour Thyroid was actually doing the job lol. Bless. He told me to come off the HC or I would get horrible things like osteoporosis. He said my cortisol was within range when tested, however I pointed out it was 'lower end' of normal at bloods, bottomed out in my saliva tests and that I was resting my adrenals and didn't intend to be on the stuff forever. He didn't suggest any further testing for the adrenals due to the low normal blood test I had last year.

I think I shall definately have to change docs. You could shuffle in dripping pus and if your blood tests were even slightly near normal the doc would say you are ok.
Symptoms don't seem to make a difference nowadays.

God bless
Dawnx
 John Kenyon, CNA - Mon Jan 19, 2009 5:48 pm

User avatar Well that's a mixed bag of an update, but at least the bloods seem to be close enough (as we say here in the US, "close enough for government work") and you are otherwise on top of things as usual, which is admirable for sure. I think the plan to switch off doctors is a good one and as you say, can't make things worse, with a chance it actually may help.

I can certainly empathize with your "attitude" toward NHS as it stands right now. I figured this to be part of the problem anyway, but hate to veer off into the political.
Actually don't hate to, just shouldn't. :)

So far so good, then, given what you have to work with. Please stay in touch over this. You at least have yourself on your side, and that's a plus not everyone can claim.

My best to you,
John
 whitbywitchuk - Mon Jan 19, 2009 6:29 pm

Will do John
And enjoy the party with Mr Obama today :) I just saw you are in Washington, must be quite an atmosphere there at the moment, whether you voted for him or not lol.

take care and thankyou
hugs
Dawnx

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