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Dr. Bob
Dr. Bob, Medical Doctor
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Experience:  20 Years in Internal Medicine, Neurology and Sports Medicine
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I done a blood test and they said my red blood cells are

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I done a blood test and they said my red blood cells are small, liver enzymes are elevated. Done MRI scan liver, pancreas, gallbladder are fine. Now I am getting breathless going up the stairs. Also feeling tired. What is wrong with me?

Hi Taj. It sounds like you might have anemia. Have you ever been told this before? Does it run in your family?

Customer: replied 2 years ago.
I have had it before. But the blood test said the ferritin level was high. The doctors have said I am not anaemic. The red blood cells are small and liver enzymes are high

What is your RBC count? Your Hematocrit?

Customer: replied 2 years ago.
Did you receive the blood test report. I attached it
Customer: replied 2 years ago.
I have started a healthy diet and exercise and vitamins to fix it. Been getting very gassy now

Your RBCs are small, on average, but you make up for it by producing more of them. Not sure why the liver tests are elevated. Are you a drinker?

Customer: replied 2 years ago.
No. Was an occasional drinker. Like 3-4 x a year. Now not at all

I didn't see the ferritin level.

Customer: replied 2 years ago.
This one was a private test. I don’t have the nhs gp one. But she said the iron was fine

Ferritin is an acute phase reactant, meaning it can go up and down rather rapidly depending on current circumstances. A persistently elevated level may indicate an iron storage disease such as hemochromatosis. Otherwise, it has to be interpreted in the context of other clinical and laboratory evidence.

Customer: replied 2 years ago.
No idea about the liver enzymes? Could it be heart disease? Or simply being overweight is enough to have elevated enzymes?

Being overweight is the most common cause of hepatosteatosis (fatty liver) and elevated liver enzymes. Other possible causes should be ruled out, however, including viral hepatitis, autoimmune hepatitis, lever infiltration, etc. This can usually be done with blood tests and an ultrasound, though sometime CT or MRI are needed for more information. If you are symptomatic, or your numbers are getting progressively worse, you may need a liver biopsy to find out the cause.

It's not likely to be heart disease unless you have heart failure and return of blood flow to the heart is impaired.

Customer: replied 2 years ago.
Ok. Then it could just be that I am overweight and was eating ocassionaly fried foods. I have stopped that now. MRI scan showed no fatty liver. That is what I thought it could be. There is nothing to link elevated enzymes and small
Blood cells? I still don’t know why I get breathless going up the stairs. I am fairly fit and can jog 20 minutes.
Customer: replied 2 years ago.
I have had heart flutter or rapid beating on two occasions. Only for a short while. But thats notenough for heart failure?
Customer: replied 2 years ago.
I did read somewhere vitamin b12 deficiency could cause small blood cells and perhaps even the breathlessness?

You should definitely get a cardiac work up if you haven't already. Atrial flutter or fibrillation is not normal, nor is shortness of breath with exertion unless one is deconditioned. As for B12 deficiency, this can lead to anemia, but the RBCs are usually large (macrocytosis). When they are small (microcytosis), we look for iron deficiency, chronic diseases, thalassemia, or hemoglobinopathies. A hematologist could test you for these things and probably elucidate what it going on.

Customer: replied 2 years ago.
Is it possible for my liver enzymes to still be elevated from my pregnancy 3 years ago. I had OC and they induced me, liver enzymes were high then. Perhaps they never came down. I stopped going for blood tests and assumed they were going down anyway.

They usually do come down if associated with pregnancy or medications that have been stopped. If they are persistently mildly elevated, this may the norm for you. But one always has to be mindful of medications, alcohol, drugs, toxic exposures, and autoimmune conditions. A rheumatologist could work you for a possible autoimmune condition that is affecting both your liver and your red blood cells.

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