Low red blood cell count?

[bluebanded goby]

I just got the results of a complete blood count that my doctor had run on me. My scores are all normal, except for two. The red blood count (RBC) came back as "lo" at 4.40 (normal range shown on the form as being 4.7-6.1 mil/mcL). Also the mean corpuscular volume (MCV) came back as "hi" at 97.4 (normal range shown as 80-94). (I've seen different "normal" ranges for this latter test in various places on the web, and according to some my MCV score would fall within the normal range.)

I'm curious about the low red blood cell score because some web pages I've seen link this with anemia. I remember I had chronic mild anemia as a kid, and took iron supplements for some time. Also I'm wondering if this can have any impact on the overall oxygen-carrying capacity of the blood. These days I primarily freedive, and my bottom time isn't all that hot. (If it matters, I was a smoker for some years as a young adult, but quit 13 years ago; currently I'm 48 y.o.)

My HMO doctor said the "lo" score wasn't really a concern at all. He said that rather than RBC he'd look at hemoglobin (HGB) as the marker for anemia, and my score was normal (14.6 within a range of 14.0-18.0 g/dL). So he told me not to worry about anything at all from the test. On the other hand I know that his instinctive tendency is to minimize until a problem gets to be fairly big. Is this low RBC score something that another M.D.s might be interested in getting checked out further? Could it have any relation to my freediving bottom time? Thanks for any input.

 

[John Reinertson]

In general, low Hemoglobin will decrease athletic performance. Your Hemoglobin is normal.

As a graying family doc, I might repeat the test before doing anything. A single abnormal test result (particularly this close to normal range) bears a double-check, and then investigate if it is repeatedly abnormal.

Do coordinate this with your doc, as a myriad of family history and personal health history concerns have to be sorted through in evaluating a finding like this.

Also, before anyone gets tempted to take a lot of iron supplements to improve their diving ability, be aware that excess iron can be toxic and can conceal other illnesses.

Dive safe and healthy,

John

 

[The Iceni]

John Reinertson once bubbled...
Your Hemoglobin is normal.

Also, before anyone gets tempted to take a lot of iron supplements to improve their diving ability, be aware that excess iron can be toxic and can conceal other illnesses.

I entirely agree with Dr R, but might add that the anaemia caused by iron deficiency is characterised by small red cells.

In any case, the haemoglobin count (g/dl) is the important factor so, BBG, you are not anaemic! It would seem your results are boringly normal. Many things can temporarily increase red cell volume in a healthy individual.

May I perhaps add that a doctor's role is limited to returning the ill to a state of health?

The ethics of performance enhancement is very questionable indeed.

I do hope this does not read as me being too arrogant and offers some reasurance.

:doctor:

 

[bluebanded goby]

Thanks for the reassuring word that my results are boringly normal.

Paul: May I perhaps add that a doctor's role is limited to returning the ill to a state of health? The ethics of performance enhancement is very questionable indeed.

This gets into a more philosophical question that, while fascinating, is probably entirely tangental to the discussion topics of this message board.

To me in this particular case I didn't feel that I was wondering "How can my doctor help me enhance my performance?," but rather, "Might I have some relatively modest medical limitation that has an impact on my diving?"

I've found that in some cases my HMO doctor appears to have a generous view of what constitutes acceptable health. One day while discussing body mass index, for example, I found that he viewed a particular range as desirable that the U.S. government categorizes as obese. In other cases, his HMO organization has published tables of scores on various tests that it considers normal that are more broadly drawn than ranges from other medical organizations. So I find that my doctor is quite good when I'm really unmistakably sick, but needs a little prodding to take seriously more subtle or borderline conditions.

Anyway, happy again to know that this particular test is not a cause for concern.

 

[The Iceni]

bluebanded goby once bubbled...
I was wondering . . ."Might I have some relatively modest medical limitation that has an impact on my diving?"

Hah!

You have hit the nail on the head here, BBG!

The one thing a good doctor will do is take a history, examine his patient and perform a number of tests to exlude serious (or treatable) pathology, whether related to diving or not. Hence we only ask for what we consider to be "appropriate" investigations.

This is when medicine becomes an art, rather than a science.

"The worried well" is a concept I like, as we all have apparently minor symptoms now and again. These may impact on our leisure activities or point your doctor into looking for a serious underlying pathology, such as an underlying cause for an anaemia in your case. Since you do not have anaemia your doctor has no need to look any further.

Then we get to your question and it is a difficult one for me (or any of the other doctors on board) to answer, in all honesty.

I suppose if you are assessed af "fit to dive" you are fit to dive and you must make your own judgement as to whether it will, by itself, impact on your future health (and visa versa).

In my own case, I have lost about 40 lbs, feel a lot better and have no doubt that I am cardiovascularly much fitter than before I started diving again, even though I do get the odd aches and pains. (For instance I now have a troublesome repetetive strain injury of the right radiohumeral joint through humping heavy cylinders but I live with it).

I hope that helps.