large red blood cells

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malka
Regular Member


Date Joined Apr 2006
Total Posts : 171
   Posted 2/17/2008 2:37 AM (GMT -6)   
My new PCP did routine blood tests and now wants me to go to a hematologist because my red blood cells are abnormally large. I never heard of this and did some preliminary research on the web. From what I read, I wonder if it has to do with a deficiency in folic acid. I take sulfasalazine which inhibits the absorption of folic acid. I take folic acid supplements. Has anyone heard of this?

Thanks for any input.

Malka
Diagnosed UC 1975. 
Azulfidine Entabs 500 mg. 4 twice a day
Azathioprine 100 mg per day
Colocort - as needed
Folic acid, vitamins C and D, multivitamin, metamucil, fish oil, turmeric 
 
Hospitalized 1997 - intravenous cyclosporine.


serendipity24
Regular Member


Date Joined Jan 2008
Total Posts : 56
   Posted 2/17/2008 3:50 AM (GMT -6)   
It's possible that the sulfasalazine is really inhibiting the folic acid absorption. It's a competitive inhibitor, meaning that the receptor that binds folate also binds sulfasalazine, and if the concentration of sulfasalazine is higher than the concentration of folate in your blood, then not enough folate will be absorbed. The other thing to be careful of is to make sure your B12 levels are sufficient, since supplementing folate can mask a B12 deficiency.

Otherwise, I haven't really heard of this nor experienced it. But I'm curious about what the hematologist tells you. Good luck!
Rachel

23 yrs old
Diagnosed with UC: March 2004 with probable IBS component

Currently taking:
Asacol 4pills 3x/day
Prograf 5mg/day
(Prograf is my miracle drug! It doesn't seem to be well known, but it's fantastic!)

Previously Tried:
Prednisone (works, but such awful side effects!), 6-MP (gave me acute pancreatitis), Entocort, Cipro (antibiotic), Bentyl, Canasa suppositories, a couple different enemas


quincy
Elite Member


Date Joined May 2003
Total Posts : 25773
   Posted 2/17/2008 3:50 AM (GMT -6)   
Interesting...never heard of it before...so, that means I'll do some surfing.

Definitely you should go to a hematologist to find out what's going on.

Why are you taking sulfasalazine instead of asacol or colazal..etc?
 
Did you have B-12 checked?  Large red blood cells can also mean pernicious anemia (from what I just read).
 
Did the doc mention if the large red cells were pale?

q


*Heather*Status: mini flare Dec 28... tapered to every 3rd night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....bromelain 1 - 2x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!

Post Edited (quincy) : 2/17/2008 1:57:34 AM (GMT-7)


malka
Regular Member


Date Joined Apr 2006
Total Posts : 171
   Posted 2/17/2008 9:48 AM (GMT -6)   
I am taking sulfasalazine because I started taking it before asacol existed - and because it works for me. I once tried asacol and the pills passed right through me.

I don't know if they tested for B-12 and I was not told that the red blood cells were pale. I do know that in the past my red blood count has been low, although within the normal range.

Thanks for the responses.

M
Diagnosed UC 1975. 
Azulfidine Entabs 500 mg. 4 twice a day
Azathioprine 100 mg per day
Colocort - as needed
Folic acid, vitamins C and D, multivitamin, metamucil, fish oil, turmeric 
 
Hospitalized 1997 - intravenous cyclosporine.


quincy
Elite Member


Date Joined May 2003
Total Posts : 25773
   Posted 2/17/2008 11:45 AM (GMT -6)   
Definitely keep us posted as to the outcome.

There are other 5ASA meds such as Colazal, Pentasa..etc. if the sulfa creates a problem.

q
*Heather*Status: mini flare Dec 28... tapered to every 3rd night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~vitamins/minerals/supplements 
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....bromelain 1 - 2x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!


demchim
Regular Member


Date Joined Dec 2005
Total Posts : 124
   Posted 2/17/2008 1:12 PM (GMT -6)   
I see that you are on Imuran.

In addition to folic acid/B12 deficiency, therapeutic levels of Imuran can also elevate your MCV (Red blood cell volume).

Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4565
   Posted 2/17/2008 1:57 PM (GMT -6)   
I happened to hear recently that abnormally large red blood cells in some populations are a variant of sickle-cell anemia which can cause fainting spells. It's good that you're going to consult a hematologist. Maybe it's time to switch your 5-ASA to Colazal from sulfasalazine. I would definitely run that by "Moses", if you're still in treatment with him. Good luck in resolving this issue. Please keep us posted! / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 Colazal daily for maintenance of remission)

chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 2/17/2008 4:41 PM (GMT -6)   
You said asacol went right through you....it is not uncommon to see the shell in your poop...

Judy2
Forum Moderator


Date Joined Mar 2003
Total Posts : 9476
   Posted 2/17/2008 4:53 PM (GMT -6)   
Macrocytosis, as it is known medically, can also be a sign that the bone marrow is making a lot of new cells - as after chemotherapy or extensive bleeding. I hope you find whatever is causing your issue and it can be easily corrected. Fortunately there are other effective 5-ASA drugs available if it's the Salofalk causing the problem.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
 
Co-Moderator UC Forum


malka
Regular Member


Date Joined Apr 2006
Total Posts : 171
   Posted 2/17/2008 10:23 PM (GMT -6)   
Thanks to everyone for the replies. I have a routine annual colonoscopy scheduled for Tuesday and will make an appointment with a hematologist after that. (I can cope with one medical procedure at a time.) I was hoping to find that all I had to do was increase my folic acid, but you people have convinced me I ought to see a hematologist.

I am no longer in treatment with "Moses." Since my colitis has been under control for a while, I decided to go with a GI who takes my insurance and promised to refer me to Moses if necessary. (He is also associated with Mt. Sinai.)

Regarding the asacol, it wasn't just the shell. I fished one out and it was the whole pill. In addition, I was having a flare which stopped when I went back to sulfasalazine.

Thank you all.

M
Diagnosed UC 1975. 
Azulfidine Entabs 500 mg. 4 twice a day
Azathioprine 100 mg per day
Colocort - as needed
Folic acid, vitamins C and D, multivitamin, metamucil, fish oil, turmeric 
 
Hospitalized 1997 - intravenous cyclosporine.


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5419
   Posted 2/17/2008 10:28 PM (GMT -6)   

When I was on sulfasalazine (10 years of UC) my doctor had me on folic acid simultaneously.  I hope that's all you need.

 

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4565
   Posted 2/18/2008 10:15 AM (GMT -6)   
Good luck with your c-scope! Worth it to ask about a switch to Colazal, I think-- so that you can get rid of the sulfa & its possible effect on blood cells. You might want to have a look at earlier thread "New Online IBD Article Summarizes Current Medical Treatment Options", Part 1 on UC. It has a chart on 5-ASA meds, re where they dissolve, etc. / Old Hat (nearly 30 yrs with left-sided UC ... [etc.])

malka
Regular Member


Date Joined Apr 2006
Total Posts : 171
   Posted 2/28/2008 1:41 PM (GMT -6)   
I went to the hematologist today and his opinion was that the most likely cause of the large red blood cells was the azathioprine (Imuran). He said that it was not harmful and there was no need to do anything. The only reason to investigate is that large red blood cells can be a symptom of various other things - none of which seemed likely in my case. He could tell definitively if I stopped taking my medication for six weeks and be retested, or through a blood marrow test. Unless things changed, however, he saw no need to do any of that. (We agreed that it was not worth the risk of a flare.)

I guess it was much ado about nothing. When I told my GI about it, he said it was probably the result of medication, but that I should go to the hematologist anyway.

So - that's the news from Lake Wobegon . . . .

M
Diagnosed UC 1975. 
Azulfidine Entabs 500 mg. 4 twice a day
Azathioprine 100 mg per day
Colocort - as needed
Folic acid, vitamins C and D, multivitamin, metamucil, fish oil, turmeric 
 
Hospitalized 1997 - intravenous cyclosporine.


cycling_sasquatch
Regular Member


Date Joined May 2007
Total Posts : 162
   Posted 2/28/2008 3:48 PM (GMT -6)   
Thanks for the update.  I recently had blookwork done and my MVC was a bit high.  Just out of the "normal" range, and in fact, within some "normal" ranges when checking it out on the web.  Good to know it is probably just the Imuran.
Dx Left-sided UC Dec. 2006
Currently:
Azathioprine 200mg/day
Prednisone 2.5; 7.5; 10/7.5mg(trying to taper-started at 60 6/1)
Lialda 2/day
Multivitamin, B complex vit., fish oil, calcium, fiber supplement, probiotic


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4565
   Posted 2/28/2008 8:11 PM (GMT -6)   
Glad to read that you had it checked out & basically got a clarification from the hematologist. Gads-- the thought of going off UC meds for 6 weeks to test for anything else is hair-raising! Hope you continue to do well & can keep us posted. I'm assuming that your gastro was satisfied with the recent colonoscopy results & therefore not inclined to change your meds. / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 Colazal daily for maintenance of remission)

Post Edited (Old Hat) : 2/28/2008 6:15:47 PM (GMT-7)


malka
Regular Member


Date Joined Apr 2006
Total Posts : 171
   Posted 2/29/2008 9:50 AM (GMT -6)   
I finally received the results of the biopsies from my colonoscopy and they are good. I did have a polyp which was a hyperplastic polyp. According to sites on the web, hyperplastic polyps are not precursors of colon cancer. So, the news is good. (They are associated with aging - sigh!)

Thank you to everyone for your input. I am happy this forum exists.

M
Diagnosed UC 1975. 
Azulfidine Entabs 500 mg. 4 twice a day
Azathioprine 100 mg per day
Colocort - as needed
Folic acid, vitamins C and D, multivitamin, metamucil, fish oil, turmeric 
 
Hospitalized 1997 - intravenous cyclosporine.


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 4565
   Posted 2/29/2008 8:48 PM (GMT -6)   
Interesting that hyperplastic polyps are a sign of aging. I had one removed in 2001 & another in 2006, when my gastro commented: "We're not worried about those." No mention of the aging factor, though. They don't want to tell us everything-- ha! Congratulations on your good scope report!!!!! It's great to have the procedures over, for a while. / Old Hat
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