High MCH, MCHC, low RDW, high Basophil %

[tallewalt]

My son has fainting spells.  Had to take him to ER yesterday morning because he suddenly fainted and fell into the bathtub.  EKG was normal, and ER said blood work was fie, but according to lab results his MCH is high (30.4), MCHC is high (35.7), RDW is low (12.0), and basophil % is high (1.3).  What does this mean?

[LivingInHope]

It sounds like your son's pediatrician needs to be advised it's time to retire before he might endanger someone's life with an improper prescription.  Have you reported the errors to anyone (aside from the doctor)?  As a student nurse, the first patient I took care of was someone who had been prescribed an overdose of medication and it wound up being life-threatening.  I think the patient was planning to sue after he got out of the hospital.  

Anyway, I'm not sure if the hematologists in your area would require a referral, but they might, so perhaps it would be best to get your son in with an adult doctor first, so they can recheck the basophils before referring.  Also, with the B-12 issue, has your son been checked to see if he has pernicious anemia?
http://www.medicinenet.com/pernicious_anemia/article.htm
Perhaps the hematologist would suggest a geneticist regarding the gene concern you have?

Also, I think you should ask his new adult doctor if he shouldn't be getting further heart testing than just an EKG with the fainting episodes- like an echocardiogram, etc..  It looks like Concerta's warning in relationship to cardiovascular on here:
http://www.drugs.com/pro/concerta.html
and his fainting episodes would be strong reasons to check to make sure his heart does not have any defect.  It looks like your son is at the top of the adolescent recommended dosage there.

Also, I recommend you get an Omron (highly rated brand) home blood pressure cuff for your son to use on a more regular basis where he can keep a record for his new doctor.  One thing you might want to do is to have him lie down for ten minutes and take his blood pressure/pulse with the machine.  Then have him stand for a full minute and take it again.  Tell me what numbers you come back with?  

Does he lift weights?  If so, has he ever had a fainting episode with that?  

[tallewalt]

Thank you for your follow-up.  My son is 17, 126 lbs., 5'9, and a wrestler.  He never has to cut weight so that is not an issue.  He does have ADHD and takes Concerta, 72 mg every morning.  He is sometimes hypoglycemic, but when the syncope happens I test his sugar and it's normal.  I've only been told his blood pressure was low a couple of times, and he has med checks every three months, and a physical every year.  Besides for these fainting spells and bad cases of boils at least twice a year, he is physically fit, works out and in great shape.  When these episodes of fainting occur, they say it's from sudden movements with a quick drop in blood pressure and/or heart rate.  He gets very hot in his head, dizzy, and then faints.  These are the only warning signs and if he does lay down within a few seconds of the symptoms he still faints.  I am concerned about the lab results because alot of them describe lack of B12 and folic acids.  I myself have the homocysteine gene that elevates my folic acid levels, they say if the levels are too high they form blood clots that can sit like a time bomb in your brain and blow at anytime.  I found this out the hard way by having a stroke due to this at 36.  Now, I'm wondering if these are signs of my son having the gene.  My son's pediatrician is 75 and starting to act kind of strange (writing wrong doses and RX's for different medication, he's been on the same meds for 8 years), so do I take him to an adult doctor, or set-up an appt. with a hemotologist, or both.  Any help would be greatly appreciated.  Trish

[LivingInHope]

Emergency doctors tend to have a laser focus on emergencies and ignore the finer details, I believe.

I have an old lab book, A Manual of Laboratory Diagnostic Tests, 2nd Edition by Frances Fischbach.  It gives a different lab range than the one your son's lab has (labs vary)... with my book's range, that MCH and that MCHC would be within normal range, but as I say, lab reference ranges vary.  The RDW (red cell size distribution width), according to my book, would actually be just slightly high.  

And the basophils (which sounds like they did a differential on the white blood cell count) would be high, even for this lab book.  It says the count of basophils is 'used to study allergic reactions.  There is a positive correlation between high basophil counts and high conentrations of bolood histamines.'

There are a list of things an increase in count may implicate and I encourage you to get another WBC with differential test run.  If it still comes back high, you may want to have his primary care doctor refer him to a hematologist for further evaluation.  

You say your son faints alot- has he been tested for dysautonomia (dysfunction of the autonomic nervous system)?  Does he have other symptoms besides fainting?  Does he tend to have low blood pressure?

Some people with dysautonomia also have mast cell activation disorder, which has flushing as a symptom and is associated with histamines- does he ever get red-skinned flushing?