(Hemoglobin 9.7 L, Ferritan 1204 H)

[EastCoast]

CLINICAL

36 year-old caucasian male
Laparoscopic Cholecystectomy 5/94
Lab 1/13/04
RBC 2.93 L
HEMOGLOBIN 9.7 L
HEMATOCRIT 27.6 L
RDW 16.0 H
POLYS 38 L
GLUCOSE, SERUM 128 H
BILIRUBIN, TOTAL 2.4 H
AST 43 H
ALT 56 H
IRON BIND. CAP 185 L
UIBC 138 L
IRON SATURATION 25
SEDIMENTATION RATE-
WESTERGREN 28 H
FERRITIN, SERUM 1204 H
TRANSFERRIN 149 L
Non-reactive HIV-1


PHYSICAL
Lower abnominal pain daily, headaches (low grade) daily, malaise.


EVALUATION

How serious and urgent a medical risk does this current condition suggest?

What blood tests and non-invasive diagnostic tests would you order?

Specify what suspected medical diseases could be indicated?

Does this medical condition require a specialist in Gastroenterology & Hepatology and/or Hematology & Oncology?

[Kevin Pho, MD]

To answer your questions:
1) The labs are significant for marked anemia, elevated bilirubin and liver function tests, and markedly elevated ferritin.  With a blood level that low, I would suggest an evaluation by your primary care provider to appropriately treat this and diagnose the cause.  

2) Next tests would be an abdominal ultrasound (to evaluate the elevated liver tests and elevated bilirubin) and a hepatitis panel.  With a ferritin that high, I would also consider a liver biopsy and genetic testing for hemochromatosis.  

3) There are many diseases that can present this way.  Any liver or gall bladder disorder, such as gall stones or hemochromatosis can present with these findings.  With a low blood count, I would also look for GI causes of blood loss - a colonoscopy would be a reasonable first test.  

4) A GI specialist would be the most pressing referral.  For the anemia, a hematologist can be consulted for further guidance.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Caroline5]

It looks like you may have some liver disease. Your ALT & AST are slightly elevated and your bilirubin is pretty high. You are also quite anemic. See a doctor ASAP.

[Mother Margaret]

I was wondering what kind of work you do?

The red blood cell anemia and concern for liver are a couple of symptoms of exposure to a chemical which is common place in businesses that deal with cleaning, oil cleanup, painting, and the like.

(I came to the forum to see what SGPT number of 7 means for a man when 30-65 is normal, and the concern seems to be for high numbers, not low)

Often the red blood cells need to be tested for RETIC ratio because they may be low functioning, and you may not have full blown hemolytic anemia, but you might have compensating hemolytic anemia.  (As long as the bone marrow can replace the prematurely dying off red blood cells, the hemolysis won't show up in the blood counts) It does look like you have the blood counts showing something, though.

Did you work on the Exxon Valdez oil spill cleanup?  You are about the right age. And the chemical they used in Inipol EAP 22 or Corext were too strong with 2-butoxyethanol (AKA  ethylene glycol monobutyl ether)  OR were you a gulf war vet?  They were exposed to this solvent and also the the more complex diethylene glycol monobutyl ether.  Fatigue is primary on their list of 'gulf war syndrome' symptoms.  These chemicals are classified not only as solvents, but also as pesticides by EPA and they do cause endocrine disruption;  they are also poisons.  They are teratogens; they cause birth defects and with enough exposure you can have zero sperm.  The list is a mile long of the harm to people; there already exist many people groups harmed who have the long term effects; they need to be medically monitored.