Blood cell counts

[usedtobecatchy]

Dear Dr:
A while back I posted a question about menopause and blood letting under the artheriosclerosis subheading. At the time I was just thinking it made sense and wondered if anyone was prescribing it.

Now, I am a little freaked. One week ago I saw rheumatologist about acheing jts (hips/fingers) and to find out if I have Lyme disease (tick bite 3yrs ago.) To my surprise, my wbc, rbc, and platelets are high and something called mean corpuscular volume is low. I don't have the Lyme results yet but there isnt much doubt.

When I searched the internet, I came up with Polycythemia vera...and even briefly considered Lupus and something with Purpura in the name. :-)

Frankly, I would be very relieved to just have Lyme. I also learned my grandmother had atypical polycythemia vera and was treated in the seventies with ?Myleran?

So, my questions:

Does Lyme disease cause the same lab values and is there any differentiating one?

Could an obese person have high rbc's solely due to lack of conditioning or oxygenation?

Can I assume the wbc is related to the Lyme disease?

And a general question about lab values-when I look in a book or on the internet, the "normal range" is broader than where I get my healthcare at. So just how do we know what normal, high, and low really are?

I looked at some Lyme websites-alot are pretty wacky-is it a respected diagnosis?

Sorry for the rambling, hope you can make sense of it-I realize Lyme doesnt really fit this forum but the poly. vera I am thinking probably does? Thanks

[CCF-M.D.-RCJ]

usedtobecatchy,

I am a cardiologist so both of these diseases (Lyme disease and polycythemia vera) are out of my range of expertise.  I think that I can provide some general guidance to your questions, however.

First, there is a difference between being slightly out of range of the normal lab values and way out of range.  Take this into account when looking at the values.

Both of these diseases are very difficult to diagnose and require exclusion of other conditions.  Lyme disease, in particular, is over-diagnosed.  You really need to see someone with expertise in this area, as might be found at the NIH or at Johns Hopkins Hospital (geographic areas that see this disease).

Lyme disease, to my knowledge, is not associated with elevations in all of the cell lines.  Furthermore, P Vera is not usually associated with increases in all three lines either, although this can happen.  Dehydration is a common cause for elevations in all three cell lines.

Obesity without sleep apnea or some other disease will not be associated with elevated cell counts.

If you want an expert opinion, try the P Vera question on the hematology or oncology site, and the Lyme question on the infectious disease site.

hope that helps.

[gregd64]

I sorry to hear about your medical problems but what does this question have to do with the heart?

[Impotant1]

Smartass !

[usedtobecatchy]

Hmmmm...What is the chief function of the heart? Pumping blood. What is artheriosclerosis? Buildup in those blood vessels. How does the buildup get there? It is delivered by the blood. Do you want clean gas or dirty gas running through your carburetor? :-)

Excerpt about polycythemia vera:
The median survival is 11 to 15 years. The major cause of death is thrombosis (blood clots causing strokes or heart attacks).

If you go to a hypertension dr, they order one list of labs. If you go to the rheumatologist, they order a different list of labs. I would not know about these latest lab results had I not pursued the tick bite question. (That test I am now told has been forwarded on to another lab for further review.)

[gregd64]

I rest my case .....  see doctors reply above

[gregd64]

Hmmmm..  I know what arteriosclerosis is and how to spell it correctly,arteriosclerosis is caused by fatty/calcium build up from high blood pressure and high colesterol... And as the doctor says " I am a cardiologist so both of these diseases (Lyme disease and polycythemia vera) My point was what does Lyme disease and polycythemia vera have to do with
this website and I was not being wise until you were. And your What is the chief function of the heart? Pumping blood question and answer has nothing to do with your question, people with leukemia  don't go see a cardiologist for the leukemia  
.. thats pumping around in there blood...

[Cibe]

Usedtobecatchy:

I have polycythemia vera.

Polycythemia vera (PV) and secondary polycythemia look very much alike - but there are differences.  There is a very specific protocol for diagnosing PV.  One of them is to "rule out" secondary polycythemia.

High rbcs is a distinct marker for PV.  Hematocrit (Hct) is the common blood cell count which would cause a physician to suspect PV.  A count of 52% or higher, for a male, and 48% or higher for a female should point to the wisdom of being checked by a hematologist who is knowledgeable about myeloproliferative disorders (MPD's) and experienced in treating PV. (Look at the reference range for Hct on your CBC lab report for the high end number applicable to your area.) If your Hct exceeds this high end number, you should talk to your PCP about your concern and ask for a referral to a hematologist for a diagnosis.

A bone marrow biopsy (BMB) is an important test in diagnosing PV.  The distribution of megakaryocytes in patients (with secondary polycythemia is normal whereas in PV there are changes. This distribution is one of the various important bits of information found through a BMB.  A knowledgeable hematologist will know to do a BMB.

You can get more answers to questions you may have re polycythemia vera by joining and posting to the MPD-Net Support group at
http://listserv.acor.org/archives/mpd-net.html

[squeala7]

geez greg! Give it a rest

[usedtobecatchy]

Thanks-I plan on asking my followup questions when I get the results of the Lyme test. The articles on p.vera all speak of a disease that is diagnosed later than sooner. These days, we go to doctors quicker and earlier, so I wouldn't be surprised if my lab values climb over time, if indeed I have it. Certainly, this is a heads up to request these labs be drawn each year. My grandmother was dx'd in 1970 at age of 70. I am only 45. So would this be a good rule of thumb: If normal is a range, then abnormal low is 1/2 of normal low, and abnormal high is plus 1/2 of normal high and anything in between should be rechecked periodically?

[Cibe]

I would not fool around with degrees of normal. Reference ranges are set by each laboratory at 95% of the numbers it finds for its normally healthy population.  If Rbc, Hgb, or Hct exceed that number, then the warning light is on.  Time to be checked by a hematologist.  Same goes for platelet count (typically high end of reference range is 350,000 or 400,000).  If the platelet count is higher, its time to see a hematologist.  The higher they get the greater the patient's risk of having a thrombotic event.  Polycythemia Vera is a  progressive prolific disorder.  It is not going to get better by itself.  It can be treated whereby the patient can lead a long normal life.  It used to be considered an "old folks" disorder.  Not anymore.  Patients from age 3 on up to in their 70s are being diagnosed with it.  I had PV four years before my Hct got up high enough (62) wherein a new doctor recognized it and sent me to a hematologist.  It had been passed over and ignored by an earilier internist.  Unfortunately this experience is too common.

[usedtobecatchy]

I am concerned about what low, normal, and high are because the day my blood was drawn was the last day, last minute really, of my six-day long period. I asked around and was told that should have had a lowering effect on the counts. I don't think my counts were alarmingly high, but with the blood loss they should have been lower, plus these counts were "normal" 5years ago? My platelet count is 422 k/mm3. Does that mean 422,000? My rbc is 5.69 m/mm3 and I don't know what number that corresponds to? Wbc is just borderline at 10.5 k/mm3. Hematocrit is normal at 43%. What I hope to do is have those counts redone during the "middle" of my cycle. It is the little things that add up. Teeny tiny miniscule little red blood "sacs" that spontaneously come and go on my neck and forearm and thigh. I bend over a tall chair applying pressure to my lower abdomen to pick something up and few days later I notice a 5-6inch bruise. First time I had no clue, but when it happened again, I realized it was the chair maneuver. Purple blotches on my shin. Always feeling like I need oxygen yet breathing normally. Sudden onset of allergies when I never had allergies. Acheing in fingers and hips not associated with movement. I even have the little white bumps by my achilles tendon :-)