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High bilirubin levels along with hemoglobin hematocrit and sleep apnea

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I am 23, male, non-smoker. I had a physical done 8-9 months ago and my bilirubin levels were high along with hemoglobin and I believe hematocrit. Everything else was normal, liver enzymes were good. I just had labs again last week and the same things came back. I do not believe that the levels were any higher than previously. I remember that the bilirubin was around 3 and the normal range was 0.2-1.0. I do have nasal polyps and the doctor suggested that I get those removed and see if that helps (possibly related to sleep apnea?). I have had some intestinal issues that I have noticed off and on in the past year (loose stools) i thought may have been food related but now I have convinced myself I have something like pancreatic cancer. Is the sleep apnea/polyps a possibility or should I be pursuing this more urgently?

Category: Hematologist

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Hello,

 

 

Thank you for asking your query at DoctorSpring.

I would require some additional information from you so that I can provide my best learned opinion.

1. I understand you had a high Haemoglobin / Haematocrit value in the blood test. Do you happen to remember or have the records to say what the exact values are?

2. The Bilirubin values are 3 mg/dl. Do you know what fraction is the direct and what fraction is the indirect Bilirubin level?

3. Do you have any symptoms related to sleep apnoea? As in snoring, feeling sleepy during days time, non-refreshing sleep etc ?

4. Do you have any of these symptoms? – Weight loss (documented), back pain, abdominal pain, fever, nausea or vomiting?

5. Regarding the polyps, Have you had an ENT surgeons opinion in this matter ?

 

Thank you 


Patient replied :

I do not recall the exact Haemoglobin but I believe the Haematocrit was 52%.  I think the value for the Bilirubin was the total and I don't think the direct or indirect were on the results.

I snore occasionally, and I don't always feel well rested but I just push through that with a cup of coffee.  I don't have any back pain, but I have had abdominal pain. It is very intermittent and it seems like it is related to gas quite a bit.  It seems to happen all over but there is one spot that I have noticed pain consistently, upper abdomen, where rib cage ends almost underneath. This pain is very dull but and I will go days without noticing it seems to be related to eating.  I was given a PPI when I was seen for this and it seemed to help a bit. This was the main reason for my concern about pancreas issues. I have seen an ENT about polyps and was recommended to have them removed.  This is something I have been meaning to get done and most likely will in the next month. 


Thank you for the addition details you have provided. 

 

1. Even though Nasal polyps is not my field of expertise,  I would recommend the surgical removal of the Polyps. You seems to have some features of sleep apnoea (more of  an airflow obstruction than apnoea) and you will possibly benefit from polypectomy. Good to know you are getting it done soon.

 

2. There are no features suggestive of a pancreatic cancer. (You have not mentioned about any weight loss. So I assume there is no major weight loss). The pain which responds to PPI is definitely ulcer related. The high bilirubin is also not related to any pancreatic issue. If that was the case there would be predominant symptoms and other liver function tests would show an ‘obstructive pattern’.

 

3. The high bilirubin and Haematocrit could be soft finding. But needs further evaluation. The high Bilirubin could be due to increased break down of the Haemoglobin. So a measurement of direct and indirect fractions will give idea in this regard.

 

The high Haematocrit / Hb could be due to a lot of reasons. Sometimes it could be just a normal manifestation, or caused by conditions such as high altitude. In rare cases tumours in the liver or kidney can cause this (due to increased production of erythropoietin). Being said that it does not mean the raised Hb is suggestive of a tumour. You will need a set of investigations.

 

1. Repeat complete blood count, including MCV and MCH

2. Ultrasound of Abdomen and Kidneys

3. Urine Microscopy for RBCs

4. S. Bilirubin with Direct and Indirect fractions

5. Electrolytes.

 

 

You should discuss these options with your Doctor. I hope I could give you a general direction on how to proceed further. These tests are simple and easily available. Once it is done and possible conditions are ruled out this will give you good peace of mind.

 

Hope this helps

Please feel free to ask followup questions

Thank you


Patient replied :

I had more labs done and the doctor called today and said that they looked at the indirect and direct and said that the "one that matters" was positive.

She said that the normal range should be at most 0.8 and mine was just over 2.

I am going to have more work done, but could you give me any information on what I may be dealing with?

I was able to finally get a copy of my blood test results.

I am seeing a Gastroenterologist tomorrow but these are the abnormal values:

 

Test Result Units Reference Interval
Hemoglobin 18.1 g/dL 11.1-17.7
Hematocrit 52.2 % 34.0-51.0
MCV 99 fL 79-97
MCH 34.2 pg 26.6-33.0
Bilirubin, Total 2.4 mg/dL 0.0-1.2
Bilirubin Indirect 2.08 mg/dL 0.10-0.80

I have also attached the complete results.

If you are able to give me any insight I it would be much appreciated.

Thank you for your time.


Hello,

 

You will require some more blood investigations. 

But do not worry, there nothing is grossly abnormal. 

 

You may need a LDH, Peripheral Smear and Coomb's test. 

 

Gilbert Syndrome is a diagnostic possibility. Glad that you are having a Gastroenterologist consultation. He/She will guide you in the right direction. 

 

Thank you


Dr. Vineel Pampati
Category: Oncologist
Experience: 
Residency: MD, Kasturba Medical College,Manipal
Medical School: MBBS, College of Medical Science, Bharathpur.
Dr. Vineel Pampati and 4 other Medical Specialists are ready to help you

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