Low blood count/anemia

Oldvatr

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Type 2
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Hi,
I've had type 2 diabetes for over15 years now and I controll it pretty well. I started to feel very tired,falling asleep a lot which doesn't make the wife happy. My doctor sent me for a comprehensive blood test including B12. When I got the results my B12 level was very low 78. normal is between 200 and 900.
I looked this up on the internet and found out something called the intrinsic factor which has to do with absorbing the B12 from food. I was then sent for another blood test to see if I had the intrinsic factor and the results came back that I did ,so I didn't have pernicious anemia.My malabsorption came from the various drugs that I take, Metformin Lansoprazole and several others .But taking these drugs over a long time can deplete your store of B12 I had to have six injections over two weeks to bring my B12 levels up and I've just had the first of my three monthly injections.
So just be aware that if you have been on Metformin for over ten years when you have a routine blood test get your doctor to include B12
Hi All,
I was on another thread and posted that I had just been diagnosed as having anemia. This derailed the thread I was in, so I called a halt and said I would make a dedicated thread for this instead, so here I am.

Yes I too have a low feritin level, with low RBC count (red count). I have been on Metformin for over 10 years, and on 2g/day for most of that time. But, surprisingly my B12 levels are fine, so that is not the reason. I am also on Lansaprazole, which can also affect metabolism of iron, but I moved this dose well into the evening so it reduced this possibility, but my levels stayed low. I was also severely Low Carbing, and wondered if this was to blame in some other way, but again this seemed unlikely. But I did increase my Vit C intake just in case. My HbA1c is 43 (7,1mmol/l avg) so I am in good bgl control.

My GP suggested a load of invasive tests I could go for, but I declined, and suggested iron supplementation instead. After 2 months of reasonably high intake my ferritin level has recovered (it takes 2 or 3 months to recover, (i.e. like HbA1c) and my folate and B12 are fine, but my RBC is still low. GP is not worried now, and we agreed to halve my iron supplement for another 2 months and then review. I have also halved my Metformin dose and halved my Gliclazide intake too, I have also cut my Furusomide diuretic to 1/3.

One thing I did find out is that a large percentage of diabetics have anemia of one sort or another. Last year the ADA reported that something like 40% of registered diabetics in USA are anemic, and I found a study report that stated 86% of the T2 diabetic test subjects were anemic, (unfortunately its a Medscape report, and requires subscription fee) The WHO stats say around 4% of general population is the normal prevalence.

I have some diabetic friends here who have been through the usual tests (top and bottom endoscopy, biopsy, MRI, NRM and various blood tests, but so far none has had a Eureka moment. So whatever it is that I have, it seems to be common among diabetics, and seems to continue to be elusive.

If my GP is no longer panicking, then why should I? He looked over my past history notes, and apparently I have always been borderline anemic, so it seems this is the way I was built.

There may be more here who have this condition but who do not know, since the normal annual GP tests here in the UK do not normally test Whole Blood Count.
 
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DCUKMod

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I reversed my Type 2
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Hi All,
I was on another thread and posted that I had just been diagnosed as having anemia. This derailed the thread I was in, so I called a halt and said I would make a dedicated thread for this instead, so here I am.

Yes I too have a low feritin level, with low RBC count (red count). I have been on Metformin for over 10 years, and on 2g/day for most of that time. But, surprisingly my B12 levels are fine, so that is not the reason. I am also on Lansaprazole, which can also affect metabolism of iron, but I moved this dose well into the evening so it reduced this possibility, but my levels stayed low. I was also severely Low Carbing, and wondered if this was to blame in some other way, but again this seemed unlikely. But I did increase my Vit C intake just in case. My HbA1c is 43 (7,1mmol/l avg) so I am in good bgl control.

My GP suggested a load of invasive tests I could go for, but I declined, and suggested iron supplementation instead. After 2 months of reasonably high intake my ferritin level has recovered (it takes 2 or 3 months to recover, (i.e. like HbA1c) and my folate and B12 are fine, but my RBC is still low. GP is not worried now, and we agreed to halve my iron supplement for another 2 months and then review. I have also halved my Metformin dose and halved my Gliclazide intake too, I have also cut my Furusomide diuretic to 1/3.

One thing I did find out is that a large percentage of diabetics have anemia of one sort or another. Last year the ADA reported that something like 40% of registered diabetics in USA are anemic, and I found a study report that stated 86% of the T2 diabetic test subjects were anemic, (unfortunately its a Medscape report, and requires subscription fee) The WHO stats say around 4% of general population is the normal prevalence.

I have some diabetic friends here who have been through the usual tests (top and bottom endoscopy, biopsy, MRI, NRM and various blood tests, but so far none has had a Eureka moment. So whatever it is that I have, it seems to be common among diabetics, and seems to continue to be elusive.

If my GP is no longer panicking, then why should I? He looked over my past history notes, and apparently I have always been borderline anemic, so it seems this is the way I was built.

There may be more here who have this condition but who do not know, since the normal annual GP tests here in the UK do not normally test Whole Blood Count.

Oldvatr, you have posted on a 4 year old thread. There's no issue with that, but if that isn't what you intended, I (or any of the other Mods) can move your post to create a thread bespoke to yourself.
 

Bluetit1802

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Type 2 (in remission!)
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There may be more here who have this condition but who do not know, since the normal annual GP tests here in the UK do not normally test Whole Blood Count.

Do you know that for certain? My on-line test results go back to 2006 and on each one I have had over these years has included a full blood count, even though mine are always normal so no need for regular checks. These were the normal annual MOT tests since becoming 60 plus all my diabetic checks since 2014.

Are you aware your HbA1c may be inaccurate due to low RBC count? Is your Haemoglobin count normal?
 

Oldvatr

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Type of diabetes
Type 2
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Oldvatr, you have posted on a 4 year old thread. There's no issue with that, but if that isn't what you intended, I (or any of the other Mods) can move your post to create a thread bespoke to yourself.
Sounds OK by me.

Edit to add : Wild thing, You Move Me.
 
Last edited:

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
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Do you know that for certain? My on-line test results go back to 2006 and on each one I have had over these years has included a full blood count, even though mine are always normal so no need for regular checks. These were the normal annual MOT tests since becoming 60 plus all my diabetic checks since 2014.

Are you aware your HbA1c may be inaccurate due to low RBC count? Is your Haemoglobin count normal?
Think it depends on the Lab your GP uses. My GP usually tests for HbA1c, TC and Haematocrit, but none of the others I get now (MCV, MCH,MCHC, RBC width, Neutrophil, Lymphocytes, Monocytes, Eosinophil,Basophil, along with serum tests such as B12, folate, ferritin, WBC, RBC, platelets)

So it is a special test that gets called up when necesssary. I got it because I asked for a B12 level check since I am on long term Metformin. Just as the Cholesterol breakdown test has to be specially ordered, I did not get one this year, but will get one next year. As you say, my records seem show low RBC, but this may just be from the haematocrit value. Either that, or as you say the full test was done, but my results may have been limited in what they decided to tell me, Certainly I am seeing a load more detail than I used to get, and the vampire is taking more blood phials for the privilege.

Not only the HbA1c, but also the bgl meter readings will be affected,
 

Bluetit1802

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Type 2 (in remission!)
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Not only the HbA1c, but also the bgl meter readings will be affected,

Is this correct? From everything I have read about this it is only the HbA1c that is affected by abnormal/anaemic RBC. Anaemic people get HbA1c results that are out of line with finger pricking, CGMs etc. Something to do with the life of the RBC and the reduced haemoglobin. I am also convinced the MCV , MCH, MCHV and RDW have something to answer to.
 

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Is this correct? From everything I have read about this it is only the HbA1c that is affected by abnormal/anaemic RBC. Anaemic people get HbA1c results that are out of line with finger pricking, CGMs etc. Something to do with the life of the RBC and the reduced haemoglobin. I am also convinced the MCV , MCH, MCHV and RDW have something to answer to.
https://www.ncbi.nlm.nih.gov/pubmed/23439176
The strips leaflet should give the working range for this that the meter will tolerate, My Caresense is 15% to 65%. and my personal level is 33% at last bloodletting session. But yes, my latest HbA1c was 43 which converts to a bgl average of 7.1 mmol/l and my running average at the time was 6.4 mmol/l so a bit low. Mind you with depressed haematocrit, it would have been forced higher so my SD Codefree may well be closest at 6.9
 

Dark Horse

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Is this correct? From everything I have read about this it is only the HbA1c that is affected by abnormal/anaemic RBC. Anaemic people get HbA1c results that are out of line with finger pricking, CGMs etc. Something to do with the life of the RBC and the reduced haemoglobin. I am also convinced the MCV , MCH, MCHV and RDW have something to answer to.
Anything which reduces the life span of red cells e.g. haemolytic anaemia can give a low HbA1c as blood glucose has a shorter time to react with the haemoglobin in the red cell to form HbA1c.
http://www.pathology.leedsth.nhs.uk/pathology/Portals/0/PDFs/BP-2013-01 Diabetes.pdf

Blood glucose meter readings can also be affected as they use an average haematocrit (or PCV) to calculate the blood glucose and the more someone's haematocrit deviates from average, the less accurate the meter will be. The meter instruction leaflet may state the haemocrit range it is accurate for.
https://www.ncbi.nlm.nih.gov/pubmed/23439176
 

Bluetit1802

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Type of diabetes
Type 2 (in remission!)
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The strips leaflet should give the working range for this that the meter will tolerate, My Caresense is 15% to 65%. and my personal level is 33% at last bloodletting session.

Anything which reduces the life span of red cells e.g. haemolytic anaemia can give a low HbA1c as blood glucose has a shorter time to react with the haemoglobin in the red cell to form HbA1c.
http://www.pathology.leedsth.nhs.uk/pathology/Portals/0/PDFs/BP-2013-01 Diabetes.pdf

Blood glucose meter readings can also be affected as they use an average haematocrit (or PCV) to calculate the blood glucose and the more someone's haematocrit deviates from average, the less accurate the meter will be. The meter instruction leaflet may state the haemocrit range it is accurate for.
https://www.ncbi.nlm.nih.gov/pubmed/23439176


My haemotocrit levels are teetering on the edge of high, so not Haemolytic anaemic. On my print outs the range should be between 0.36 to 0.46 Are these percentages or some other measurement?
I am using an Accu Chek Mobile having reverted to this lovely meter from a Codefree. I cannot find any reference to haemotocrit levels in either the meter booklet nor the strip cassette leaflet or box.

Along with MCH and MCV levels also teetering on the edge of high, could this be why my HbA1c is always significantly higher than my self testing across all situations and my Libre lead me to expect?
 

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
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My haemotocrit levels are teetering on the edge of high, so not Haemolytic anaemic. On my print outs the range should be between 0.36 to 0.46 Are these percentages or some other measurement?
I am using an Accu Chek Mobile having reverted to this lovely meter from a Codefree. I cannot find any reference to haemotocrit levels in either the meter booklet nor the strip cassette leaflet or box.

Along with MCH and MCV levels also teetering on the edge of high, could this be why my HbA1c is always significantly higher than my self testing across all situations and my Libre lead me to expect?

From the Accuchek site:


Influence of hematocrit

The influence of hematocrit level on the results was
investigated with native capillary blood samples of
254 patients. Hematocrit levels were available in the range
from 24% to 53%.
The result (deviation Accu-Chek Mobile
system to the laboratory method Hexokinase, IFCC
plasma) is shown in Figure 12.
In an additional laboratory experiment the hematocrit of
venous blood samples was manipulated artificially to cover
the range from 0% (plasma) to 65%.
Both experiments prove that clinically correct results are
produced in a hematocrit range from 25 % to 55 %

Note: Hematocrit = the ratio of the volume of red blood cells to the total volume of blood. so multiply the fraction result by 100 to get percent.
 

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
Treatment type
Tablets (oral)
From the Accuchek site:


Influence of hematocrit

The influence of hematocrit level on the results was
investigated with native capillary blood samples of
254 patients. Hematocrit levels were available in the range
from 24% to 53%.
The result (deviation Accu-Chek Mobile
system to the laboratory method Hexokinase, IFCC
plasma) is shown in Figure 12.
In an additional laboratory experiment the hematocrit of
venous blood samples was manipulated artificially to cover
the range from 0% (plasma) to 65%.
Both experiments prove that clinically correct results are
produced in a hematocrit range from 25 % to 55 %

Note: Hematocrit = the ratio of the volume of red blood cells to the total volume of blood. so multiply the fraction result by 100 to get percent.

Edit to add: the ranges are different for men and women. Your upper limit is slightly above my lower limit.