Low blood count

[ANTONISH]

I'm not worried but curious to know the reason for my low blood count - I'd always thought it was associated with iron levels - perhaps I need some altitude training.

Anaemia caused by iron deficiency is very common, but there's a vast list of other causes.

Jonathan

Thank you for that but I doubt under the present circumstances that a GP will pursue the matter when presented with a patient who appears well and has no detectable problem apart from the blood count.

[millimole]

(40 years in Biochemistry and Haematology laboratories but retired for 12 and now completely out of date with modern thinking)

I'd say a Hb of 123g/l (12.3g/dl) in an otherwise healthy male would be 'interesting' and worthy of 6/12 month follow up, but not with any great urgency. The important bit being 'otherwise healthy' - if there are any signs of increased fatigue, hair loss, GI problems, then it'd probably be more than 'just interesting'.

Folk get hung up on the absolute numbers, and so-called normal ranges, but we are all different and unique. The trend over time for almist any biological measurement is much, much more useful.

I'm not (and never have been) a doctor. Proper medical advice is better than anything that random people post on the Internet.

[531colin]

Its all about the best use of NHS resources, isn't it?
I expect a GP when faced with a man of 80 who can ride 100K will probably think, well, I can't do that, and most other people can't either, so he must be OK.
But there are 2 things which irritate me....
One, bad practice. It was drilled into me, long ago....if you get abnormal results out of the machine, look at the blood film. .....don't they do that any more? because thats when you find out whats going on. If the rbcs are oversize, there are only a few possible causes.
Two, who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries, including obesity and alcohol/drug abuse....and people who can't decide what sex they might like to be, or who are "depressed" by the tripe they read on "social media" ...they all ought to get out on their bikes!

[Jdsk]

One, bad practice. It was drilled into me, long ago....if you get abnormal results out of the machine, look at the blood film. .....don't they do that any more? because thats when you find out whats going on. If the rbcs are oversize, there are only a few possible causes.

Yes, it's still done. But in some situations some other investigations (eg quantitative biochemistry such as serum ferritin concentration) has moved upstream in the plan of investigations.

In the UK the best library of guidelines is produced by the British Society of Haematology and is open to the public:
https://b-s-h.org.uk/guidelines/

Jonathan

[Jdsk]

Two, who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries, including obesity and alcohol/drug abuse....and people who can't decide what sex they might like to be, or who are "depressed" by the tripe they read on "social media" ...they all ought to get out on their bikes!

In England it's increasingly done by NICE on the basis of cost-effectiveness:
https://www.nice.org.uk/about/what-we-do

And predominantly out in the open.

Both of which are better than the alternatives.

Jonathan

[axel_knutt]

who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries

There won't be any shortage of those who think that a cyclist who's dragged out from under a bus and taken to A&E has self inflicted injuries, particularly if he wasn't wearing a helmet/using the cycle lane/wearing Hi Viz etc.

[531colin]

who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries

There won't be any shortage of those who think that a cyclist who's dragged out from under a bus and taken to A&E has self inflicted injuries, particularly if he wasn't wearing a helmet/using the cycle lane/wearing Hi Viz etc.

Of course it would be stupid to wear a helmet inside a car, when the biggest number of head injuries occur in car occupants.

[531colin]

Two, who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries, including obesity and alcohol/drug abuse....and people who can't decide what sex they might like to be, or who are "depressed" by the tripe they read on "social media" ...they all ought to get out on their bikes!

In England it's increasingly done by NICE on the basis of cost-effectiveness:
https://www.nice.org.uk/about/what-we-do

And predominantly out in the open.

Both of which are better than the alternatives.

Jonathan

But on the one hand we are still producing children with cerebral palsy, and on the other hand there is currently a 12 year old being kept alive against medical advice.
A simple man might want to transfer the effort from one case to the other.

[Jdsk]

Two, who decides what is a good use of resource? I think there is far too much money spent on self-inflicted injuries, including obesity and alcohol/drug abuse....and people who can't decide what sex they might like to be, or who are "depressed" by the tripe they read on "social media" ...they all ought to get out on their bikes!

In England it's increasingly done by NICE on the basis of cost-effectiveness:
https://www.nice.org.uk/about/what-we-do

And predominantly out in the open.

Both of which are better than the alternatives.

But on the one hand we are still producing children with cerebral palsy, and on the other hand there is currently a 12 year old being kept alive against medical advice.
A simple man might want to transfer the effort from one case to the other.

If that's a reference to Archie Battersbee please could you propose a better approach. The advice from the NHS organisation is that in his interests for life support treatment to be withdrawn. Of course his parents should have a right to challenge this. We resolve these conflicts when necessary through the legal system.

This has very little to do with deciding how the limited healthcare expenditure that's available should be allocated.

Jonathan

[531colin]

It seems to me that avoiding misuse of an intensive care bed has a great deal to do with deciding how money is allocated.

NHS treatment doesn't normally encourage free choice made by the patient or relatives; for example I must wait for treatment for my cataract until it is judged that treatment is appropriate; presumably there is a NICE guideline for this.

I don't think its necessary for me or anybody else to "propose a better approach". I would simply expect that the advice of the people responsible for the treatment should be followed....ie treatment should be withdrawn. Unless there is somebody with a better understanding of the case?

[Jdsk]

It seems to me that avoiding misuse of an intensive care bed has a great deal to do with deciding how money is allocated.

NHS treatment doesn't normally encourage free choice made by the patient or relatives; for example I must wait for treatment for my cataract until it is judged that treatment is appropriate; presumably there is a NICE guideline for this.

I don't think its necessary for me or anybody else to "propose a better approach". I would simply expect that the advice of the people responsible for the treatment should be followed....ie treatment should be withdrawn. Unless there is somebody with a better understanding of the case?

I think that it's entirely right that the parents should be able to challenge the decision of the healthcare provider in this sort of case. You seem to be saying that they shouldn't.

Jonathan

[Jdsk]

... for example I must wait for treatment for my cataract until it is judged that treatment is appropriate; presumably there is a NICE guideline for this.

It's here under "Referral for cataract surgery" and some other sections:
"Cataracts in adults: management":
https://www.nice.org.uk/guidance/ng77/c ... ct-surgery

Jonathan

[IanH]

Returning to the original question, at the age of 69 I'm occasionally rejected by the Blood Donation Service as my haemoglobin level needs more time to recover from my previous donation. I eat red meat and green vegetables, and lots of oranges. However, it may be significant that this has only occurred during the last few years.
There's lots of information on this at the blood donation website:
https://www.blood.co.uk/the-donation-pr ... -and-iron/

[ANTONISH]

Returning to the original question, at the age of 69 I'm occasionally rejected by the Blood Donation Service as my haemoglobin level needs more time to recover from my previous donation. I eat red meat and green vegetables, and lots of oranges. However, it may be significant that this has only occurred during the last few years.
There's lots of information on this at the blood donation website:
https://www.blood.co.uk/the-donation-pr ... -and-iron/

That's how things went for me.
I had to extend the time between donations and the time came when being rejected for the third successive time I decided to give up.
Thanks to all for the information.

[joeegg]

About 2 months ago my blood test result showed borderline anaemia so it was off to the doctors for an appointment.
After a few questions and prodding of my stomach the doctor said they would approach it as bowel cancer and so test accordingly. I was shocked.
Having had a triple bypass just over a year ago i asked if any of the tablets could cause the anaemia. Yes,aspirin and ticagrelor which i took daily. I was a bit disappointed that i had to prompt another reason for the anaemia.
Speaking to a friend who is a medical professor the first thing he asked me was are you taking aspirin.
I went through all the tests,including cameras internally,and all was clear. I have now got a few months on iron tablets.
The blood test also showed borderline diabetic and again the doctor seemed reluctant to point the finger at tablets.