Before I graduated from nursing school, I told myself I would blog more often...especially about the trials and tribulations of my first year as a nurse. Ha. I've been way too busy, way too exhausted and way too overwhelmed. I've been working at my new job in the ICU for eleven weeks and this is the first time I've even felt like sitting down to write about it. But, truth be told, that's not what is on my mind this morning...I am dealing with some troubling lab results and that seems to be all I can think about.
I went in for my annual "girlie visit" and asked the NP about getting my cholesterol screening done. She said she'd like to throw in a CBC and chem panel as well, so I said, "sure"! You know how us ICU nurses love data...the more the merrier! So I get my results back and started with the cholesterol (excellent), worked through the chem panel (fine and dandy) and then got to the CBC (not awesome). The results are troubling and I am wracking my brain trying to "self-diagnose" myself into a non-terrifying explanation (I've since had a follow-up draw, so that's the second set of results):
WBC: 10.2, 10.9 (normal...whew!)
RBC: 6.56, 6.66 (range 3.6-5.7)
Hgb: 17.1, 17.2 (range 11.5-15)
Hct: 51.8, 51.9 (range 34-46)
MCV: 79, 78 (range 80-100)
RDW, RBC: 17.5, 18.5 (range 11.9 - 14.3)
PLTs: 859, 858 (range 140-400)
Of course, I made a little diagram showing all the possible causes for each of these results (per my lab book, so probably only a portion of the possible causes, but I had to start somewhere). The happiest, very best explanation for the elevated RBC & Hgb would be that I am chronically, chronically dehydrated. I know I don't drink enough water...I absolutely know it. I am hoping like hell this is the reason. The other possible cause is polycythemia vera, for which there is no cure. Even if I don't have PV (and knock on wood that I don't), a RBC and Hgb this high is pretty scary...stroke, organ dysfunction and pulmonary embolism have all been circling around in my head for days. Sadly, as a nurse, I know just enough to scare the crap out of myself...but not enough to be reasonable and rationale.
Moving on to the high PLTs, I've been hoping against hope that I have an iron-deficiency anemia (because, trust me, the alternatives are way cruddier than that). AND THIS JUST IN!!! I just got a lab result back and my ferritin level is 9 (normal is 22-291)!!! Ok, normally this would be huge cause for concern, but I feel like this is something I can control. The other possible causes (things like cancer, polycythemia vera, rheumatoid arthritis, inflammatory conditions, chronic heart disease, cirrhosis, essential thrombocythemia, leukemias, pancreatitis, TB, ulcerative colitis) are super scary.
The thing that's throwing me is that with I.D. anemia, my RBC and Hbg would be low...but possibly the dehydration is causing such hemoconcentration that it appears high despite the anemia? I did have microcytes...which is also a sign of anemia...so I don't know. I am definitely feeling better about things than I did when I sat down to write this, but I am pretty sure my doc will send me to a hematologist. In the meantime...I'm upping my water intake to 12 glasses a day and eating iron-rich foods. I've been a pretty lazy vegetarian for a while now, and am hoping I won't have to resort to eating meat. Hoping I can just get back to eating lots of greens and such...we shall see. This is scaring the pants off me, so I will do whatever I need to do to get healthy...even if it involves eating a cheeseburger. Let's hope it doesn't come to that.
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