Anemia and High Platelet Counts in Diabetic Patients

Blood test shows anemia and thrombocytosis?

Good evening, doctor.
My wife is 60 years old and has type 2 diabetes without complications for over two years.
Her blood pressure is 143/77, and her heart rate is approximately 113.
She has been taking the prescribed medication to control her blood sugar.
Recently, I noticed that her complexion has become somewhat pale, but she does not feel dizzy.
We took her for blood tests, and the results are as follows:
First blood test:
- White blood cells: 9,710/µL
- Red blood cells: 3.54 x 10^6/µL (low)
- Hemoglobin: 7.8 g/dL (low)
- Hematocrit: 75.1 fL (low)
- Lymphocytes: 18.8% (low)
- Platelets: 705 x 10^3/µL (high)
- Urine leukocyte esterase: 2+ (high)
- Urine occult blood: 2+ (high)
- Urine protein: 1+ (high)
- Urine hemoglobin: >=100 cells/HPF (high)
- Urine white blood cells: >=100 cells/HPF (high)
- Estimated glomerular filtration rate: 76.73 mL/min/1.73 m²
- Serum calcium: 9.1 mg/dL
- Serum sodium: 138 mEq/L
- Serum potassium: 4.4 mEq/L
Second blood test (about 20 days later):
- White blood cells: 11,840/µL (high)
- Red blood cells: 3.09 x 10^6/µL (low)
- Hemoglobin: 6.6 g/dL (low)
- Hematocrit: 22.5% (low)
- Mean corpuscular volume: 72.8 fL (low)
- Basophils: 0.3% (normal)
- Eosinophils: 0.6% (normal)
- Lymphocytes: decreased to 12.7% (low)
- Monocytes: 6.3% (normal)
- Platelets: increased to 757 x 10^3/µL (high)
- Albumin: 3.2 g/dL (low)
- Urine ketones: Trace (high)
- Urine leukocyte esterase: 2+ (high)
- Urine occult blood: increased to 3+ (high)
- Urine protein: increased to 2+ (high)
- Urine hemoglobin: 20-29 cells/HPF (high)
- Urine white blood cells: >=100 cells/HPF (high)
- Estimated glomerular filtration rate: 79.09 mL/min/1.73 m²
- Serum sodium: 137 mEq/L
- Serum potassium: 4.4 mEq/L
Could the above abnormal results indicate leukemia, or is it simply nutritional anemia? If she requires a blood transfusion, how long would one bag last? What complications might arise if left untreated, and what further tests should be conducted? Thank you, doctor, for your careful interpretation and response.

Li, 60~69 year old female. Ask Date: 2024/02/20

Dr. He Dongjin reply Cardiology

Hello, it is recommended to visit a hematology department for further examination due to worsening anemia and increased platelet count.
It would be prudent to investigate potential issues with the hematopoietic system.
Changhua Hospital cares about your well-being.

Reply Date: 2024/02/20

More Info

Anemia and elevated platelet counts can be concerning findings, especially in a patient with a history of type 2 diabetes. Your wife's blood test results indicate anemia, as evidenced by low hemoglobin levels (7.8 g/dL and 6.6 g/dL) and low red blood cell counts. The elevated platelet count (705,000/µL and 757,000/µL) is also noteworthy.
Anemia in diabetic patients can arise from various causes, including nutritional deficiencies (such as iron, vitamin B12, or folate), chronic disease, or renal impairment. Given that your wife has diabetes, it is essential to consider the possibility of anemia of chronic disease, which is common in patients with long-term illnesses. Additionally, the presence of protein and blood in the urine, along with a reduced estimated glomerular filtration rate (GFR), suggests potential kidney involvement, which can also contribute to anemia.

The high platelet count (thrombocytosis) can be a reactive process, often seen in response to inflammation, infection, or iron deficiency. However, it can also indicate a primary bone marrow disorder, such as essential thrombocythemia or other myeloproliferative neoplasms, including leukemia. Given the combination of anemia and thrombocytosis, it is prudent to investigate further.

To determine whether these findings are related to leukemia or another hematological disorder, additional tests are necessary. These may include:
1. Bone Marrow Biopsy: This test can help assess the bone marrow's cellularity and rule out malignancies such as leukemia or myelodysplastic syndromes.

2. Iron Studies: To evaluate for iron deficiency anemia, including serum iron, ferritin, and total iron-binding capacity (TIBC).

3. Vitamin B12 and Folate Levels: To check for deficiencies that could contribute to anemia.

4. Reticulocyte Count: To assess the bone marrow's response to anemia.

5. Peripheral Blood Smear: This can provide information about the morphology of blood cells and help identify any abnormal cells.

Regarding blood transfusions, they can temporarily improve hemoglobin levels, but the duration of benefit varies depending on the underlying cause of anemia. In general, a single unit of red blood cells can raise hemoglobin by approximately 1 g/dL, but the effect may be short-lived if the underlying cause of anemia is not addressed.

If left untreated, anemia can lead to significant fatigue, weakness, and decreased quality of life. Severe anemia can also strain the cardiovascular system, potentially leading to complications such as heart failure, especially in older adults or those with pre-existing heart conditions.

In summary, your wife's condition warrants further investigation to determine the underlying cause of her anemia and elevated platelet count. It is advisable to consult a hematologist for a comprehensive evaluation and management plan. Addressing any nutritional deficiencies, managing diabetes effectively, and monitoring kidney function will also be crucial in her overall care.

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