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Recurrent Internal Bleed?
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Recurrent Internal Bleed?

I have been suffering from problems for 3 months after a neck injury. I have gotten repeated episodes where I feel what seems like a tear in my neck when I do something moderately strenous followed by what feels like hot liquid spreading outwards for several seconds. It is usually followed by neck stiffness/soreness and a general malaise feeling that lasts 1 hour to 1 day or so. I am 29 yr old male in good shape (until I had to stop exercising for this 3 months ago).

I have had MRIs & xrays that show nothing wrong with my neck. I have also seen chiro's, ENT, internist, physicatrist. All say nothing is really wrong. But my symptoms keep coming back. Other symptoms are general fatigue, higher than normal heart rate (that usually goes up 30-40 bpm just standing vs sitting), increased thirst, continued neck pain, headaches of varying degrees & type.

I asked my dr's if there is any chance I broke a blood vessel, tore a muscle, etc that I might be reinjuring, causing sporadic internal bleeding. But they all say that is impossible.

I convinced my PCP to give me another CBC test (the first was on the first day of all of these symptoms). Here are the results. Based on what I have read, this all is suggestive of internal bleeding:

Test - Nov1 result/Jan 28 result
----------------------
WBC - 7.5/6.0
RBC - 5.0/4.58
Hemoglobin - 14.4/13.3
Hematocrit - 42.4/38.1
MCV - 84/83
MCH - 28.6/29
MCHC - 34/34.9
RDW - 12.6/12.8
Platelet Cnt - 270/200

I know the results aren't a 'slam dunk' for internal bleeding. But if I have had sporadic bleeding with episodes happening every 4-5 days (depending on what actions I take that trigger them), I feel that this is about what the blood would look like. Hemoglobin and Hematocrit have gone from the low end of normal to below normal, especially for a male.

My internist has shrugged this all off as no indication of anything. How hard should I follow this possible diagnosis?
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Avatar_m_tn
to know if you are losing blood, have a reticulocyte count with the CBC as hemoglobin and hematocrit can be affected by hydration status.  compute for your reticulocyte production index.  a value greater than 2.5 would indicate losses, either via rbc destruction or bleeding.  how did you injure your neck previously?  how was it managed? did you manage to hurt your head also?  were the MRI done only on the cervical level or did it include the head?  i'm no expert (just in my 4th year med school) but i think you should think of asking another internist's opinion, maybe an internist-endocrinologist?  Have you also seen a spine specialist?  i hope you get your answers.
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