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Possible Causes other than bleeds for Low Ferritin, Iron, MCH,Hb,MPV
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Possible Causes other than bleeds for Low Ferritin, Iron, MCH,Hb,MPV

Hi
The following results have just been obtained in a 57 year old Euthyroid Graves Disease male patient.   What other causes, other than GI bleeds and Colon Ca (both of which have been ruled out) could result in the following CBC levels and very very low Ferritin level.

Hb 12.4 L
MCH 24.5  L
MCHC 29.9 L
RDW 15.1 H
MPV 6.6 L
Iron  45 L
Iron binding Capacity Profile w/o Iron  unsaturated Iron Binding Capacity   374  H,  Total Iron Binding Capacity 419 H, % Saturation  11 L
Ferritin  7 L
Vitamin B 12   999 H
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649848_tn?1424570775
Lots of things going there, but one jumps out at me...... RDW being high could indicate Pernicious Anemia, but the high B12 might rule that out...... not sure if the patient is on B12 therapy.

Hb, MCH, MCHC, MPV, are all indicators of issues with the red blood cells, which carry oxygen to all parts of the body; these could have a variety of explanations; not necessarily related to thyroid.

Low iron, also indicates iron deficiency anemia, but could be something wrong with the ability to use the nutrients. Low ferritin indicates no iron storage.

What treatment has the patient received for Graves?  Anit-thyroid med, RAI, TT?  Is the patient on any type of thyroid replacement med?  If so, which one, at what dosage?

What are actual current thyroid hormone levels? Be aware that just because the patient is "in range" doesn't mean euthroid; that's a clinical term indicating that the patient falls within the normal ranges, but doesn't guarantee they feel good.

Patient should be tested for at least TSH, Free T3 and Free T4; please be sure to include reference ranges, since these vary lab to lab, so must come from the patient's own lab report.
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