Elevated H/H, very low Folic Acid/B12

[EsslingerNP]

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.

[KatieMI, BSN, MSN, RN]

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.

[KatieMI, BSN, MSN, RN]

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.

[TuxnadoDO]

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.