Elevated H/H, very low Folic Acid/B12

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One year s/p bariatric surgery. Hemoglobin 19 and Hematocrit 56 (high) all other indices completely normal. Folate 300 ng/mL. (very low) and Vitamin B12 180 (very low)!

Anyone else make sense of this? I'm personally redrawing everything in two months but I referred to hematology.

Specializes in ICU, LTACH, Internal Medicine.
16 hours ago, TuxnadoDO said:

...or cancer.

Relatively common, only one type of it. Polycytemia vera or MGUS going into this direction with prevalence 22-24/100000 (well, there are a few more, but they are closer to dinosaurs than to zebras). Overall, this is a possibility rare enough to worry about at the first stage of DDx. All very common "horses" (smoking, dehydration, etc) should be reliably excluded before specialty referral.

Specializes in ICU, LTACH, Internal Medicine.

https://www.hindawi.com/journals/bmri/2013/205467/

Part 7. Copper deficiency and MGUS-like changes in bone marrow, can lead to high Hb till the iron stores run low.

Specializes in Emergency medicine.
58 minutes ago, KatieMI said:

Relatively common, only one type of it. Polycytemia vera or MGUS going into this direction with prevalence 22-24/100000 (well, there are a few more, but they are closer to dinosaurs than to zebras). Overall, this is a possibility rare enough to worry about at the first stage of DDx. All very common "horses" (smoking, dehydration, etc) should be reliably excluded before specialty referral.

Actually I was referring secondary polycythemia due to EPO-secreting tumors, like RCC. Seen a few in the ER I picked up with a CT scan after abnormal CBC. But I agree the other more common causes of secondary polycythemia should be considered first.

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