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slightly high RBC count
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slightly high RBC count

am 51 years old and recently had a complete blood work-up performed including liver panels, kidney panels, etc..  The results were all normal except for a slightly higher than normal red blood cell count; all other results including liver enzymes was normal.  The doctor explained that the elevation of red blood cells could be from a B12 deficiency or drinking too much alcohol.  Since I described myself as a social drinker she dismissed this. Note:  I do drink 1 glass of wine daily and 2-3 glasses on weekends.

  Earlier this year I had a nutritional  "blood analysis" done by a wellness company marketing vitamins and was told that I had "RBC's clumped together which were donut shaped indicating low iron and undigested protein circulating in the blood at a "level 3 or preventative steps encouraged".  Additonally, the analysis showed fungal forms found within the blood probably from a poor assimilation of carbohydrates as well as a yellow or greenish cast to uric acid crystals which according to this company meant higher levels of monosodium urate from undigested protein; and spirulated RBC's with projections indicating dehydrated cells.

My question is since the liver enzymes are normal should I be concerned that the RBC count is elevated due to liver malfunction vs. a vitamin deficiency?
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It all means nothing. I am so sorry you were sent on that scary, expensive roller coaster of misinformation about your health.

If you understood the results correctly, they are contradictory and nonsense. Slightly elevated red cells occur all the time-they are calculated from other data only, and meaningless.  All red cells are shaped like doughnuts (except with sickle cell anemia, and you would have known if you had sickle cell years ago if you have significant African American ancestry--There is no such thing as spirulated cells. You may mean spiculated red cells (or white cells).If you really had spiculated red cells (echinocytes) consider this: Echinocytes are often found as meaningless artifacts on blood smears! They can be produced in the lab by putting them into a very acid solution (your blood isn't very acid or you'd be dead) or in the presence of high calcium concentrations (your calcium level was normal), exposure to glass surfaces (on the slide-voila), in reduced albumin concentrations (your albumin is normal or a healthy high), and after prolonged storage (very likely if your blood was sent off someplace). See? The statement that you have “spirulated cells” is meaningless, even if it’s true. A second form of spiculated cell (acanthocytes, but you cannot tell these from echinocytes without an electron microscope) reflects severe liver disease (you don't have this). If you did you’d have abnormal liver and other tests, or, severely abnormal spleen or a blood cancer, and probably be pretty sick. You definitely don't have any of that (you have normal white blood cells, hematocrit counts, and blood proteins).

There's nothing wrong with your absorption or use of carbohydrates and protein. Your labs would be profoundly different if so, and you'd be passing gas all the time. If you had 'fungal forms' in your blood, you'd be very sick, have fevers, have multiple organ involvement, and likely be dead by now: You don't. It's complete nonsense. There are no uric acid or urate crystals in blood. They may occur in urine. Coloration is meaningless.

I know these privately run tests were terribly expensive, and it sounds like the company may be trying to sell you vitamins? About this doctor who spoke with you: is this doctor related to that lab? Icelandic, if you don't have the credentials of the “doctor” with whom you spoke, you should ask for them-I bet she isn't a doctor of medicine, if she’s any kind of  genuine doctor at all (You can buy an essentially fake doctorate off the Internet for a whole lot of money and 2 weeks of your time).

Now back to your labs. While the automated labs may be accurate, albeit incorrectly interpreted, giving the ring of authenticity, the rest of this report is complete nonsense. The microscopic report and interpretation especially are nonsense. Frankly it sounds like the same report they give to everyone, since they don't know what they are doing.

Please go to a regular, US trained and licensed MD. It sounds like you need both reassurance and facts (I'm giving you facts). If you have insurance you can repeat the labwork at a fully qualified, certified, controlled lab, in the USA at no cost to you. Even if you don't have insurance coverage, genuine testing probably will cost you significantly less than you paid for the "wellness" labwork (and, you can shop around the several labs available in your community & hospitals for the best price). You'll see: the next time your labs are drawn, your red cell count will be normal. Your blood smear will be perfect. Your urine may have urate crystals, but this is normal 80% of the time.
OK you are normal. Better than many adults, in fact. In the USA we do recommend you drink no more than 3 glasses of wine a week. However if you really are drinking only one (normal size) glass daily, but not smoking cigarettes, you may do fine. Remember though: females metabolize alcohol differently than do males. One 6 ounce glass of wine for you is like 8 or 9 ounces for a male.

OK that's it. I hope others learn from your experience. Maybe you should report your experience to CLIA, which certifies labs, and your state.

As for me and my advice: I am a genuine American MD. I graduated in California from a real medical school, and trained in California at real hospitals. I am fully licensed. Before I went to medical school I received my BA and went to graduate school in Molecular Biology.

Sincerely yours,
An MD with no financial agenda, only concern for you.
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