Resection, azathioprine, and blood tests

[BqHM7z7Ks8sP]

After resection at ileum and Crohn's diagnosis a year ago, my doc started me on azathioprine. Since then, three of my blood measurements have drifted slightly out of the normal range.

WBC, AUTO 4.6
HCT, AUTO 36.3
MCV 102.0

My question: are these slightly out of normal range blood measurements common with aza and Crohn's common or should I be alarmed?

Thanks,
Jay

 

[alex_chris]

WBC stands for white blood cells and yes, it should be low, this is the main (beneficial) effect of aza. I was anywhere between 3.8 and 5.0. Target should be anywhere between 4.0 and 4.5 which is the normal range.

Increased MCV and decreased HCT, are a sign of iron or vit B12, or other deficiencies. This is not really connected to azathioprine, and rather to a potential malabsorption of the deficiency that causes the change. It is common for Crohn's patients, especially after a resection of part of the lower small bowel to have malabsorption problems. Supplemental diets (E.g. liquid supplemental nutrition), supplemental pills etc. might help here. How is your diet generally? Are in remission? IS there any diarrhea or other symptoms?

 

[BqHM7z7Ks8sP]

Thanks for the feedback. I forgot to mention that I am also slightly anemic (RBC, AUTO 3.55). I have been eating b12, iron, etc. but can't fix it.

I am 71 years old. Is it a problem of old age or should I consult a hematologist?

 

[alex_chris]

If you got problems from anaemia, I would ask your doc. It looks like you have some iron malabsorption that induced anaemia. What type of iron supplements do you take? Often, different types help differently. A test of how much long term iron (ferritin) is in your blood, might help to figure out if iron is too low. If it is, then iron infusions every couple of months can help, or a more stringent iron supplement regime (e.g. I not only take iron supplement tabs, but also drink dissolvable iron).

 

[DEmberton]

Are you getting B12 injections? After an ileum resection you should be, as that's where 99% of B12 is absorbed.

 

[BqHM7z7Ks8sP]

No B12 injections, just pills. However, I was anemic before my symptoms began and resection. I suppose that the Crohn's damaged my Ileum before my symptoms appeared.

How about iron? Do I need to inject that too?

 

[DEmberton]

Yes if your terminal ileum was diseased it wouldn't have been absorbing B12 properly. I was anaemic and B12 deficient before being diagnosed and before surgery. Since surgery I get B12 injections every 3 months (though Americans seem to get them every month). In theory oral supplements can still work in high enough doses, even for the likes of us, but it'll be an uphill battle and injections are cheap and much more effective.

B12 deficiency can be misdiagnosed as dementia in older people, and dismissed as "just a problem of old age". So it's something to be on top of.

Not sure about iron. A lot of people here seem to need iron supplements or infusions; it seems to be a normal part of Crohns.

No need for alarm, but some things to ask your doctor about.

 

[BqHM7z7Ks8sP]

Thanks for the feedback guys!

Jay