Looking back through four years of lab results, I noticed that one test has almost always come back flagged as "high" - MCH.
Now, I admit, it hasn't been very high, just one or two points over the top of the range, but given that we've turned over just about every rock looking for the source of my fatigue, what if this is the one we've missed?
So I asked my family practitioner why she thought it was constantly elevated. She said that it was likely due to consuming alcohol. *rolls eyes* As anyone with fatigue will understand, drinking alcohol is strictly a special-occassion-one-glass kind of thing, as it puts me to sleep almost instantly.
"Honestly, Penelope...We can't follow every trail you find in your lab results", she said in her usual annoyed voice, "some people just have a higher level than others".
Well...OK, but when I feel AWFUL for years, do you think we could just consider that it might be meaningful?
So, other than knowing that MCH means Mean Corpuscular Hemoglobin, what does it indicate (other than alcohol abuse) and is it really normal to be out of range for years on end?
Is it wrong that I'm pissed off at her non-answer?
I don't think it's wrong to be pissed off at all. Your doctor was very dismissive of you, which is never a good feeling for a patient (or an appropriate response). I can relate to her frustration, as it's frustrating at times to not be able to figure out what's going on with a patient, but it's still important for doctors to not externalize that frustration on their patients.
ReplyDeleteAs for the causes of an increased MCH, there are quite a few. Some of the more common include vitamin B12 deficiency, folate deficiency, hypothyroidism, alcohol abuse (which you've already established isn't the case!), liver failure, bone marrow disorders (usually in the presence of multiple other abnormalities on the CBC), and COPD. The important thing to remember about any lab value, however, is that "normal" ranges are determined to encompass 95% of the general population, therefore 5% of the population will have an abnormal lab value despite being completely "normal". Having a high MCV in isolation doesn't necessarily mean anything, particularly if the various causes of a high MCV have already been ruled out.
Please note that this is just a generic answer, and in no way is medical advice! (Have to add in that disclaimer.)
Hi SolitaryD,
ReplyDeleteThanks for the very informative (and not-at-all-to-be-construed-as-medical-advice!) response.
My physician's frustrations are understandable, she has looked dozens of possibilities and still not found answers for me.
I just hate that I feel like I'm taking up too much of her time. One of the reasons I joined a concierge medical clinic was to have more access to my doctor.
I wish I could pay for an hour with a doctor, just to talk freely and have my questions answered.
Unfortunately, our system doesn't allow that option; which is too bad, because 10 minute visits are better suited for tonsillitis, rather than mystery ailments.
:-) P.
well solitary has a good start on it. Those factors are more likely to alter MCV (mean corpuscular volume) in a detetcable way; often the MCH doesn't seem to change appreciably. Basically, if you don't have the stuff you need to make the cell wall (eg. folate) then you make bigger cells and pack more stuff into them (so you have a larger mean cell volume).
ReplyDeleteIf you were acutely anemic and started making a lot of new cells, you might have lots of large, packed ones... but you'll see a wide RDW errrr this is getting complicated... variance in cell size, basically. But anyway, you'd have other abnormalities on the test aside from a big MCV or MCH.
MCH is kiiiind of the same thing but looks at how much hemoglobin is packed in to each cell. This is a calculated not a straight-up measured value. They just divide the Hemoglobin by the RBC - so if your Hb is on the higher end of normal and your RBCs are on the lower end of normal, it could look like you have a big MCH.
Clinically this is rarely relevant and certainly used less often than an MCV. Being a calculated value I think as long as your other indexes are normal, there would never be a reason (or even a way) to further investigate this.
oh looking back at it, that's a terrible explanation! if you were in the office, I'd draw you a picture. That's so much easier :)
ReplyDeleteHi just got back my blood test results my RBC is low and my MCH is high, any suggestions Docotr :)
DeleteI wish I were in your office! Pictures do say a thousand words, don't they?
ReplyDeleteYou and SolitaryD have given me a good starting place to think about my results.
I'm actually wondering if I could have the MTHFR mutation. I'm wondering if one reason for having higher MCV & MCH levels could be not having enough available folic acid to build new cells?
Between my Factor V Leiden, super-low ferritin levels, and treatment resistant depression... I'm thinking it might be worth it to take the genetic test (if I can find it in Canada) and see if my body is making usable folic acid.
Thanks again for shedding some light on this lab result.
Praying you find answers soon - and perhaps a more understanding doctor?
ReplyDelete((hugz))
Jamie
Thanks Jamie, I'm praying for answers too.
ReplyDeleteI wish I knew how to relate with my doctor better.
There is really not a way to relate. Doctors are
ReplyDeletesuperior people. They don't like to be questioned, or
persuaded to see a different viewpoint. Period. I have
seen the syndrome for 20 years, even when they have made blatant mistakes. You have to decide not to believe
in their competence, and to go only so far as your funds
or insurance, and your judgment, will carry you. Use them
as PART of your decision. Don't beat yourself up. Don
Hi Penelope,
ReplyDeleteMy same exact issue brought me to this page and I was wandering whether you have found the cause and/or solution to your slightly elevated MCH levels? I have tried to investigate this further but always got tired of the system and my doctor's responses so I have given up, but not for good though. When I have the energy, I periodically run another round of tests but always encounter the same issues. I moved to another country and I am thinking of looking into this again in hope someone will help me finally.
Please let us know what's the status of your situation. Thanks so much and hope you have found answers.
have you ever had your home tested for mold? it took me years to figure out why i had chronic fatigue!docotrs never figured it out until i told them AND found a specialist. one of my symptoms was elevated MCH
ReplyDeleteIf you take a proton pump inhibitor (prilosec, nexium, etc) for extended periods of time it will inhibit your body's absorption of B12 and folic acids although your body will still absorb it through supplemental b12 and folate. Take supplements to get your MCH levels up and increase oxygen being carried from your lungs into your blood stream. ***not medical advice, just neighborly advice***
ReplyDeleteSounds like b12 deficiency to me. I had completely normal
ReplyDelete'everything'on the indicators front apart from a slightly raised MCH and a low serum b12 that nobody had bothered to read.. Turns out I also had low ferritin (even though my iron was normal) folate. Without the b12 result my GP would have been looking for the cause of symptoms for ever and a day. Trouble is the serum b12 is not accurate as it measures total b12 in bloods. Total includes haptocorrin which is useless and the serum assay doesn't measure b12 at cellular level. What you also need to have done is MMA and Retic count. Neuro symptoms that would indicate these tests are position and vibratory senses being affected - such as shoulder bumps, foot placing etc. All the other tests can be affected by diet or other deficiencies and therefore nothing in macrocytic anemia shows up, normal MCV, RBC - it's all normal. Also I understand that b12 is acute phase reactive so can go into the normal range simply if you are stressed. Get all three tests done and see how you get on?
^ Yes. I would suggest you look into B12 deficiency.
ReplyDeleteDoctors are not really good at collaborating with your medical diagnosis. You just have to keep trying. My new physician did not accept that high blood pressure, high blood glucose (should have had diabetes II diag), high chlor, GERD ect., was normal for my age and physical condition. He put me on a gluten, dairy, and legume free diet and the results were amazing. It all went away except I stayed on the high blood pressure diaretic. I lost 9 pounds of water weight in four days. In a couple of months...I started to have brain fog, confusion, poor memory, horse sh** spelling; anxiety, muscle spasms in my neck and shoulders, fatigue, headaches, IBS, and the list goes on. I went back to same doctor who ran a lot of blood tests then passed me off as beign stressed out. Some of those tests were boarderline low or high but apparently not enough to peak his attention. After that I saw an ETN, two gastro specialists, had aGI scope, physical therapist, barioum swallow test, chriopractor, allergist, allergy testing, gyno (hormones), and a psychiatrist. Yea, I was put on Xanax for anxiety. I stopped using the word "anxiety" to describe my symptoms. Every physican went "she is just stressed." Xanax eventually became a daily medication. I suspected a chemical inbalance or issue so I added a water filtration system at home, change all my storage containers to glass, stopped cooking in plastic in microwave, bought mostly organic food, gone Paleo with my diet, use natural soaps and that list goes one. BP still high so went back to original doctor and I taked and taked. I would not let him leave. He finally ordered a lot of blood tests again. I got the somber phone call the next day. Looks like Aldosteronism, low t4, very low WBC, and high DHEA. Did the spit cordisole test yesterday and did not take any Xanax before hand. The aldosterone test wss not ordered before but the cordisole was and I never got a good answer on that result. I may have goofed that one myself because I was in so much neck and shoulder pain, I used up some old muscle relaxers. After not accepting "anxiety" as a diagnosis but as a symptom, I finally got an answer, not a good one, but an answer nonetheless. Adrenal tumors.
ReplyDeleteStick with it if you do not get the answers you need. I learned from a friend of mine who survived two difference cancers because she knew something was wrong and did not stop until a physician actually listened to her.
penelope
ReplyDeleteThere are 2 possible answer endocrine / MTHFR i have similiar MCH readings mine use to be 36 which is high my b-12 were 400 so doc put me on b-12 injection they got as high as 1600 b-12 blood serum levels but i still had symptoms brain fog and fatigue and lots more long story short i have MTHFR/endocrine problems
hypothyroid, hypogonadism, adrenal problems cortisol was low side of normal, dhea was low, my doc has worked with me on HRT
hormone replacement therapy was put on cerefolin nac for MTHFR
i have both gene mutations which is why i have high homocystein levels which are now improving since taking the methyl b vitamins
and p5p (b6) more active form i was checked for cancers so far none have been found thank God I am not a doc but hang in there and change doc if you have to i have been thru 20 docs since all this began and the doc i have now has done the most every day i have more hope. Good luck and God bless there are answers just don't give up also remember nutrition is also very important i take over 30 supplements to keep every thing metabolizing properly enyzmes very important.
How strange. I have low RBC & high MCH & no Dr's ever take that seriously. Not that I do either, but (a) I am now pregnant & (b) I was just thinking "if its B12, I'll just up mine so I get back into normal range" (after google diagnosis of course!). Well, guess what? I have 2 copies of MHFR too! My mouth almost dropped to the floor when I read yours & Anon's posts. I am currently 16wks pregnant, but tried so many times & lost 4 babies AND had trouble getting pregs, so that's how we found my MTHFR (but homocysteine ok). Currently on lovenox injections into the stomach, L-5-MTHF, B6 & B12 (Metanx). I have only gotten this far b/c I DEMAND treatment & if 1 Dr doesn't give a sh**, then I go to another, then another, then a naturopath, acupuncturist, etc! Its really truly sad as this takes so much time, $ & effort - just to find that 1 Dr out of 15 that "may care".
ReplyDeleteGet MTHFR test & get tested for those vits like the one lady said (10/21/12 Anon) - I am going to go get her tests as I was also told that my B12 & B6 tests just weren't very reliable bc of something-or-other (measures blood not absorption? whatever) so you have to get special tests.
Good luck!