I am somewhat anemic and have been trying to figure out why. My GP ordered some tests. I had blood drawn on Friday and picked up some results but not all of them the same day.
My WBC continues to be fairly low.
My RBC is just a tiny bit low.
HGB is a tiny bit low.
The test result that is freaking me out Is the Immature Reticulocyte Fraction which is high. Having this, which can be caused by Type 1, sounds like a death sentence.
Since my doctors probably haven’t seen the results yet, I am dealing with the results myself.
Has anyone ever had a high Immature Reticulocyte Fraction? I had never even heard of it.
Yes I know what this is. I was a clinical scientist for many years, now I switched to engineering.
I’m one of the few old guard people who can still read blood from a slide and a microscope, instead of an instrument profile.
A reticulocyte is an immature red blood cell. It indicates that your body is struggling to keep up with RBC production.
When it hits that tipping point, your body starts pushing out the cells before they are ready. Those are reticulicytes.
The problem is, that they are also much less able to do the job of shuttling oxygen to cells.
This actually makes the situation worse and you fall into a loop.
You and your doctor need to find out what the true issue is, which is usually some chronic bleeding, maybe internal.
Or it could just be that your bone marrow is not able to keep up.
I know that you are currently nearly vegan. Usually people with your blood issues will be encouraged to eat more animal protein. There is also an Injectible drug, which it seems like you won’t need if you are only slightly anemic.
Don’t worry as much about WBC if you are not sick, it’s ok.
But wbc also requires protein to produce.
Your hemoglobin is low because your red cells are low so it makes perfect sense.
This is not a big deal really, just need to find out why you are losing blood or not making enough, and also check your iron levels.
Marilyn, I think it’s healthy and smart to be curious about your blood test results. I am usually skeptical about my doctor’s actual knowledge beyond the accepted facts within the community of practitioners. Learning a few things about the situation will enhance your ability to ask good questions of your doctor, especially to suss out the level of their comfort and knowledge about the topic.
I think it would be wise to consider how your way of eating may be contributing to this condition or not. What I would worry about is the contrast between the specific nutrients in what you eat versus the nutrients that are actually absorbed or bioavailable.
When I found out that I have coronary artery disease I discovered that my hematocrit, red blood cell count, and hemoglobin were all slightly under the lab’s normal lower limit. This caught my eye since I learned that iron deficiencies can contribute to heart disease. I had success with taking heme iron pills for many months.
You’re smart to take proactive action when you discover something like this in the lab numbers.
I also have read that if the immature Reticulocyte fraction is high then hemolytic anemia is diagnosed. From what I understand Type 1 can be the cause of this and then what I read gets very scary.
The kidneys can also be involved, but my kidneys test out well. I don’t have any of the symptoms that are talked about except for some, not a lot, fatigue.
My WBC, RBC, and HGB have been somewhat low for years. I have never had my Reticulocytes tested before.
My ferritin, iron, Transferrin, TIBC, and saturation levels are all in range. The rest of the iron tests had to be sent out, so I haven’t seen those results yet.
Yes Terry, I always want to know as much as I can when I discuss my labs with my doctors. I always thought that my WBC, RBC, and HGB might be somewhat low because of my diet. I wasn’t worried about it partly because I had plenty of energy.
I had a colonoscopy, in 2019 when we were looking for sources of blood loss. Of course urine was tested too. We decided not to do an endoscopy. I had a cystoscopy last week, so I know that my bladder is fine.
This time we are extensively looking at my level of iron to see if there is info not shown with the regular iron and ferritin tests. Those results aren’t back yet.
I have been more fatigued and my memory isn’t as good as it was, but I figured that was a result of decades of type 1 and age.
So did taking iron raise your levels?
I hope that my doctors look at my labs tomorrow. I left messages at their offices. I don’t like dealing with the unknown. I need a plan that gives me some control. I sure don’t want bad news though.
Thanks Timothy and Terry for trying to help me. I appreciate it very much.
Yes, taking a heme iron supplement did raise my levels. For many years I noticed that my A1c consistently ran about 0.5% above the levels reported by my CGM. During this time period I read a study that iron deficiency anemia can skew the A1c level by about 0.5%.
After supplementing heme iron for several months the next A1c test came within 0.1% of the number predicted by my CGM glucose levels.
I stopped taking the iron pills because I had read that it’s not good for most people to supplement long-term. I am eating more red meat in the last few years and also cook with cast iron cookware, something I’ve been told helps with iron absorption.
I had never taken an interest in anemia before this episode and my knowledge is very basic. I’m not familiar with all the types of anemia but now know that iron deficiency anemia is the most common type.
If I were you and I didn’t feel that your doctor is sufficiently familiar with your case, I would seek a referral to a hematologist, a specialist I didn’t even know existed until your post sent me do some quick reading about anemia.
Hemolytic anemia is an easy diagnosis. When your blood is spun down to get the serum, the serum will be pink or red instead of pale yellow.
However usually with hemolytic anemia, your hemaglobin will run high, because all the hemaglobin leaks out into your serum.
And there is pad and atherosclerosis where the cells rupture from blood vessels that are narrow and not smooth.
It could still be that but a slight case.
Can I ask what your retic count is? Are we talking 2% or 5% or more? It’s normal to have some retic like a half a percent.
And your rbc and hgb and hct? And Mchc, which will tell you if your cells are balanced or deficient. 33.3 is perfect.
Meaning your rbc is about one third hemoglobin.
I had a surgery and lost a little blood, not a lot and I didn’t get any transfused, but my retic went to 7% for a month after.
But there are a lot of reasons your cells rupture, like an implanted heart valve, or a leaky spleen, and of course protein deficiency. Where the cell membrane is weak because there isn’t enough protein to make the membrane strong enough.
I mean you don’t need to eat animal protein for that last one but maybe a protein supplement could help.
No matter what it is, it seems like it’s not time to panic. I think you will be fine with some kind of small tweak to your food or meds
Retic, automated 0.69. 0.40-2.70%
Reticulocytes,ABS 0.027. 0.016-0.123
Immature Retic Fract 3.60H. 0.17-0.43
RBC. 3.94 L. 4.00-5.40
HGB. 11.8. L. 12.0-15.0
HCT. 36.4. 35.0-
MCHC. 32. 32-36
EOS. 6 H. 0-4
I think I know why that was high
Those numbers are not really so far off to be worried.
The only one that is I suspect is the fraction.
This number is telling you that the retics are more immature than average, but still that number isn’t that big.
It could be a kidney hormone not translating properly, which is common in people with arterial disease. There is a drug that is easy to deal with if that is the case. It’s called Epotin.
Your red cells have a decent amount of hemoglobin in them, you just don’t have enough of them, and your marrow is struggling to replace them. So iron is less likely the issue, but total count is the issue, back to hemolytic issues, needing to be ruled out. But because your hemoglobin matches your rbc, I would say less likely.
Your Eos are a type of white blood cell that fights parasites.
But diabetics have slightly increased numbers because we are constantly poking holes in our skin. So that is totally normal.
I really think you can breathe easy until you talk to your doctor, your issues are minor at worst. Good think you are so on top of it.
Generally speaking, blood results are not released to a patient unless a doctor has reviewed them. And they didn’t call you, so that’s an indication it’s not something that is urgent or pressing, still has to be explained tho.
Keep us informed ! We’re thinking about you and wishing the best.
Thanks Timothy I appreciate you giving me your opinion. I won’t worry as much now.
I always pick up my lab reports a few hrs after they have been drawn. I am positive that my GP has not seen these and won’t until tomorrow, since he doesn’t work on Friday afternoons.
I like to know what the results are before discussing them with my doctor. Normally I am familiar with what is being drawn.
That’s good that you can get that, in California your doctor needs to see them first, but really, we pay for them we should get the results.
When I worked in a hospital lab, we were under strict limits not to give results to anyone but a doctor. sometimes patients would call, but we couldn’t say.
Of course that’s been 8 years now, but I don’t think the law has changed
What has changed is that most clinics send your blood out to the same labs you can now go to on your own and for a relatively low fee and have pretty much any test done you want and then get your results online, UltaLabs, LabCorp, Quest diagnostics etc.
In Washington St and Idaho I have always picked my labs up. I also stay away from physicians who won’t allow their patients to pick up their own results. I figure that I am paying for it and it is my blood.
I am much more prepared for appointments this way, given that I have had time to formulate questions.
@Timothy has been very informative on the higher reticulocyte counts. Thanks I like to learn!!!
If you decide on iron…
Floradix works really well for anemia. I’ve used it in the past before menopause, I ended up with really really low iron level from heavy periods. It’s a catch 22 because low levels cause you to bleed more. Floradix worked within a few months at double doses. I had a girlfriend have a severe ongoing anemia problem and it cleared up hers, besides numerous customers in my old store that had success with it.
It would be really hard to get too much iron from Floradix, but iron is one of the most essential minerals but also the one that’s easy to get too much of and can be bad for you.
If you decide on more protein, there are several protein powders, whole foods, raw or unprocessed that are easy to add to foods or to make smoothies with. Edaname carries a nice high level. I don’t think you like the fake meats or seitans as being to processed but quite a few of those carry a large protein portion.
I am only slightly familiar with a low reticulocyte count as I had a dog that ended up with it from a bleeding disorder and a medication killed her bone marrow when they tried to suppress her immune system.
Thanks Marie. My GP doesn’t think that having a low immature Retic Fraction means that I need iron, but he also seemed a bit confused. My functional doctor thinks I need iron but he too doesn’t seem to understand much about immature Reticulocyte Fraction. From what I read, having a low immature Retic fraction does not mean low iron.
My GP suggested that I see a hematologist if I want to. I think that I do.
I am still a bit worried about having hemolytic anemia which is not from lack of iron.
Timothy seems to know more about this than either of my doctors.
I guess I will try taking some iron since my GP said it wouldn’t hurt if I want to, but if it helps he thinks that would mean that I am losing blood.
Both of my doctors think that my diet is fine and not the cause of my problems. They both happen to be vegetarians.
I am a bit concerned that my alc was 4.8. I was expecting it to be 5.3 since I have been really watching my lows. I rarely go very high though.
Thanks for the recommendation I really appreciate it!
It looks like folks on this thread are pretty knowledgeable about reticulocyte counts and the like.
Which is great because none of my doctors appear to know much (or care much?).
I got a reticulocyte count test done to try to explain why my a1c is so impossibly low (4.1). The reticulocyte count I think explains the situation pretty well:
RETICULOCYTE, ABSOLUTE: 166980
RETICULOCYTE COUNT, AUTOMATED: 3.3
The absolute # is way out of range (90k max).
, while the automated is within range(?). I’m assuming this explains my inaccurate a1c, as red blood cells are flipping over top quickly.
There appears to be little else in my bloodwork that indicates anemia.
For me it is:
Retic, automated 069
Mine are low normal
Do you know what your Immature Retic Fract was?
My A1c is normally 5.1, so I am not sure that my 4.8 has anything to do with the Reticulocyte numbers. I need to do more reading.
My GP told me that I had taught him something when I explained that there can be a link between A1c and Reticulocyte
When I read about low a1c’s the example the writer gave was an alc of 3.
Jon, how did you know about the link between low alc’s and Reticulocyte numbers?
Timothy, you might want to read what I wrote to Marie and Jon.
My GP thought that my labs were fine, but when pressed suggested that I see a hematologist.
Thanks again for all of your help.