Is This Anemia?
February 20, 2013 10:18 PM   Subscribe

I have very low RBC and WBC yet my hemogloblin is normal. Can I still be anemic?

My CBC panels came back and the old news of high HCV, low RBC, low WBC with a normal range of Hemogloblin showed up. IKYNMD but the one who is can't seem to give me a straight answer and all I want is the facts and what I'm looking at here. A blood relative has aplastic anemia and pernicious anemia was once mentioned to me as might being a factor - way back in time. Since then I've been feeling really weak and fatigued. Have the Epstein Barr virus in my blood as well. Any info would be greatly appreciated. TIA
posted by watercarrier to Health & Fitness (7 answers total)

Anemia is a diagnostically pretty confusing concept, the Greek it comes from literally just means a lack of or insufficient blood - and that is pretty much what it has always been. We now have a more sophisticated understanding of the ways in which 'blood' can be 'insufficient' for the transportation of oxygen that can include either an insufficient production of the Red Blood Cells that transport the hemoglobin that transports oxygen (also known as aplastic anemia, which low counts of both white and red blood cells can be indicative of), an excessive loss of Red Blood Cells through hemoraging, an excessive destruction of Red Blood Cells generally in the recycling pathway, various ways those Red Blood Cells can be malformed that prevent them from functioning properly, or or an insufficient concentration of hemoglobin itself. A proper assessment of whether your low Red Blood Cell and White Blood Cell counts and your symptoms are in fact indicative of anemia, that is your blood being insufficient for the task of properly transporting oxygen, and if so why, would depend on a number of factors we don't have access to but your doctor did, like just how low they are and other aspects of your medical history. If your doctor was unwilling to give you a straight answer I suspect that may be because there may not really be one, if in your doctor's judgement they could not tell you - 'Yes, you have a clear presentation of anemia' or 'No, you clearly are not presenting with anemia' - that would be a perfectly valid but kind of confusing thing to communicate.

Somewhere around 95% of all adults have the Epstein-Barr virus hiding in the genomes of their white blood cells, really a latent infection by it is more or less part of being human. It is something worth remembering if you ever become HIV+, and has been associated with various cancers like Hodgkins lymphoma and various autoimmune disorders, but there really isn't anything that can be done for it. I happen to be among the rare-ish population of people who happened to have probably never been infected by it, and thus my White Blood Cells do not have detectable copies of it hiding in their genomes, but aside from a slightly lower chance of getting a variety of rare diseases the only effect this has on my life is that the Red Cross is a lot more interested in my blood so they can use it in premature infants and AIDS patients who are more sensitive to active infection by the virus.
posted by Blasdelb at 2:47 AM on February 21, 2013 [1 favorite]

Is there a nurse at your practice that you can talk to about this stuff? Sometimes nurses have more time to explain things in detail if you don't understand them. If you have Hep C you might want to talk to a specialist Hep C nurse.

Since then I've been feeling really weak and fatigued.
I'm not sure if you mean since you were told about your cousin, or since you had the blood test. If it's the latter, this might be a result of your anxiety surrounding the test results. All the more reason to talk to someone who knows what they're talking about, but also knows you and is able to give you time and understanding to help you to understand what might be going on. You have a right to have your medical treatment explained to you in terms you understand.
posted by Acheman at 3:04 AM on February 21, 2013

Can't comment on the significance of your results, but I think rather than HCV, you mean MCV (hence the confusion in Acheman's answer about hep C). It stands for mean corpuscular volume. Sounds like you need a different doctor, if the one you have can't comprehensibly explain your results or the plan.
posted by treehorn+bunny at 7:05 AM on February 21, 2013 [1 favorite]

If you have low red cell counts and a high MCV, could it be macrocytic anemia? Did your doctor mention anything about vitamin B12 or folate deficiency?
posted by reformedjerk at 7:13 AM on February 21, 2013

Can you ask for a referral to a hematologist? If you are feeling weak and fatigued and the doctor cannot explain it, I would ask for a referral. I've had the fatigue from a low RBC before and I know it's no fun. Your quality of life is key. Best wishes for finding a solution.
posted by icanbreathe at 7:44 AM on February 21, 2013 [1 favorite]

Have they tested your serum ferritin? My understanding is that sometimes you can have normal other stuff (really technical, I know but IANAD) and still have low iron stores, which can cause fatigue. (This happened to me.) But there are tons of things that can cause fatigue and weakness. Thyroid, B12 deficiency, etc. B12 deficiency can be related to pernicious anemia or be a problem on its own.

About ferritin tests:

Did you tell your doctor you are feeling weak and fatigued? If this is all the blood tests they did, you need a new doctor. Or heck, you need a new one anyway because the current one didn't explain your test results clearly.
posted by purple_bird at 9:23 AM on February 21, 2013 [2 favorites]

Anecdotally, my doc told me that the most likely causes of high MCV are vitamin B deficiency and alcoholism.
posted by Pax at 10:20 AM on February 21, 2013 [1 favorite]

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