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[shrosphirelass]

I had a follow up appointment today to discuss my blood tests. My liver function and red blood cells were both unsatisfactory but they weren't severely so, and had had similar reading last year. The dr said that the red blood cells were too fat, which is often found alongside unsatisfactory liver function. He said I wasn't anemic (despite me feeling very dizzy and breathless) and my vitamin B12 was fine. Does anyone know what "fat" red blood cells mean? He seemed to suggest it could be to do with medication  / alcahol. I was on back to back painkillers for 3 months for severe toothache, I have recently started amitriptyline (for associated facial pain) and have had less alcahol free days since Christmas, but I am a complete control freak and never drink more than a couple of glasses of white wine as it causes headaches. He suggested doing a repeat blood test in a month and cutting back on alcahol consumption. I have root canal tomorrow so will probably need pain killers again for a while.

[Taz2]

Fat red blood cells are caused by a different type of anaemia called megaloblastic anaemia. From what I remember it's either low vit B12 or low folate. Low folate can be caused by alcohol I think. You feel fatigued with this type of anaemia and breathless among other things. A work colleague had this but it's some years ago now so I can't remember much more about it.

Taz x 

[Uptick]

Hi there,

I think your doctor is referring to Macrocytosis which can be Megaloblastic or Non-Megaloblastic. Megaloblastic is usually caused by vitamin B12 and/or folate deficiency (as Taz2 says), but Non-Megaloblastic is related to liver issues, which seems to be the case. Quoting Medscape website

'Diagnostic Considerations

Diagnosis of the etiology of macrocytosis is required to guide treatment and determine the patient's prognosis. No complications are directly attributable to the increased size of the red cell; complications are attributed to the condition causing the macrocytosis. Failure to diagnose and treat the cause of the macrocytosis is a medicolegal pitfall. In addition to the conditions listed in the differential diagnosis, liver disease should also be considered.

Macrocytosis of liver disease is secondary to increased cholesterol and phospholipids deposited on membranes of circulating erythrocytes. This deposition effectively increases the surface area of the erythrocyte.'

If your liver function results show abnormal results I guess that's the cause for the 'fat' blood cells. Good thing is that liver issues can be caused by the painkillers you have been taking and as long as you give your body a rest from these drugs (ask your dentist for a liver-friendly painkiller) your liver will be able to regain proper function. Alcohol is a no no, though. Another differential diagnosis is hypothyroidism, have you been checked for thyroid hormones recently?

[Taz2]

Thanks Uptick. My memory of it is patchy so your info is really useful!

Taz x 

[shrosphirelass]

Thanks both. I had a thyroid blood test and vitamin B12. Hopefully it will be back in the normal range in a months time. I have been feeling very tired, dizzy and a bit breathless which I thought were caused by bleeding and possibility a side effect of the amitriptyline

[Taz2]

I read that if the cells are too large they can't exit the bone marrow to deliver enough oxygen into the bloodstream.

Hopefully it will have sorted itself out by the next test.   

Taz x