True Anemia? Idiopathic? I am worried

[circadrt]

Male 59. Fibromyalgia, very sedentary-"de-conditioned," hypogonadism. Recently had a CBC.  RBC slightly below at 4.16, WBC 6.0, Hgb 14.0, Hct 39.9, MCV 95.5, MCH 31.4, MCHC 32.7, RDW 13.0, Plats 139,000, Neut 43.2%,  Lymphs 49%, Mono 7.8%. GP decided I had dropped a little in my RBC over past year or so. Sent blood off:  PBS, (see below) reticulocyte count (all normal), folate (normal),  B-12, (high,at 1980), Ferritin, (slightly high 363),  Iron- normal, Iron binding- normal, iron saturation-normal, Lytes - all normal, Vitamin D - normal, Liver Panel: normal but Albumin low at 3.7, ALT 43, Folate 16.3, BUN & all other tests normal. Report: "Erythrocytes normochromic & normocystic without anisopoikilocytosis. No nucleated red blood cells, stippling or red cell inclusions found. Leukocytes consist of lymphocytes, possible increase in large granular forms. The neutrophils are normally segmented & granulated. Monocytes, eosinophils & basophils are not increased. Platelets appear to be present in number consistent with the cell count. No agglutination or satellitism is identified. Diagnosis: Mild relative neutropenia. Borderline normocytic anemia without significant anisopoikocytosis. Borderline thrombocytopenia.  Comment: The finding of a questionable increase in large granular lymphocytes in a patient with relative neutropenia raises the possibility of a disorder of large granular lymphocytes; however, reaction to viral infection can produce these findings. Other possible causes to consider include reaction to medications and hyperslenism." If a disorder of large granular lymphocytes is suspected clinically, investigation by flow cytometric study of the peripheral blood may be useful. If this does represent a mild anemia for this patient, the RPC indices and morphology would be most consistent with a chronic simple anemia. The accompanying Ferritin and iron studies support this possibility."  My doc says "Don't worry.”  Suggestions - comments plz.

Thanks!

[circadrt]

Dr. Keyes,

I forgot to mention, although I am sure it is not germane here: I have very mild venous reflux in my right great saphenous vein per in office duplex sonogram, but the vascular surgeon said it was so minor all I need to do is wear mild (15-20mm) compression socks and also to build up my de-conditioned ( another side effect of that!) calf muscles. I have the exercises for that and am working on it and am asymptomatic at this point.

Thx.

[circadrt]

Hi Dr.

Thanks very much for the comments. We have done everything to test for any bleeding internally  - all negative. So at least I feel good about that. I know my FMS would improve if I got on the treadmill. I also know my anxiety would also improve if I did that. It's hard to discipline, but I am going to try.

My doctor says in older patients mild anemia - esp. with chronic illness - normocytic anemia is not uncommon. I will try not to worry.

Thanks,

circadrt

[J.M. Keyes, MD]

Hi there,
You are lucky to have a physician who you have a long standing relationship with.  He is probably right in that it will be something to monitor, but I tend to be on the conservative side and agree that doing those follow up tests are a good idea, if for nothing more than to give you peice of mind.  
The only other thing I would mention is that anyone your age with anemia (really anyone your age should be screened anyway) should have a colonoscopy, but it is likely that at 59 you have had one.  If it has been several years, it may be time to consider a repeat.
Your type of anemia is not typical for what you get with blood loss, but having a colonoscopy is a good idea anyway, if you have never had one.

I know that with fibromyalgia it can be difficult, but when you say you are deconditioned, I think that your overall health (physical and mental) would be well served if you tried to get yourself back to a somewhat active state.  I don't know your situation, but starting with baby steps and increasing your activity will help you feel better.

Good luck.
JMK MD

[circadrt]

We have sent blood off peripheral blood flow cytometric study. My doctor says he has done much more testing (including tests to rule out auto immune diseases such as double stranded DNA test, etc) than he usually would because he knows  I am so anxious. he is not worried and says absent symptoms from me and with all the testing we have done, no enlarged spleen or liver, he thinks this will turn out to be something to just monitor, but all the rare and nasty things have pretty much been ruled out either because they are hereditary or my tests I have had ruled them out. He is very good and thorough and has been my doctor for 21 yrs. So he does know my medical situation well.

Thanks.