OpenHealth Q&A

Unexpected Hematological Findings After Suspected Focal Seizures

Recently, I visited my doctor believing I was experiencing focal seizures. My symptoms included a phantom aroma—specifically the scents of wood smoke and rubbing alcohol—accompanied by brief, intense panic attacks, prompting me to close my eyes and ground myself to prevent fainting. This troubling sensation occurred twice, giving me what felt like a roller coaster experience. Despite a familial history of epilepsy—including diagnosis in my father, aunt, grandfather, and son—my physician expressed skepticism about my condition being epilepsy. Given that I am 36, she speculated that the neurological issue would have likely manifested earlier if it were genetic. Nevertheless, she referred me to a neurologist while simultaneously exploring various other possibilities. To begin, she requested an array of diagnostic tests. At 5’4” and weighing 110 pounds, my BMI is calculated at 18.8. During my appointment, my blood pressure was a low 94/63, with a notably elevated heart rate of 116—quite unusual for me. My oxygen saturation level was checked at 96%. The lab results revealed intriguing results, especially within the complete blood count: - White Blood Cell (WBC) count: 7.5 (typically, my range is 3 to 3.5) - Red Blood Cell (RBC) count: 4.2 - Platelets: 155 - Hemoglobin: 13.1 (noted for future reference) - Hematocrit: 40 - Mean Corpuscular Volume (MCV): 97 - Mean Corpuscular Hemoglobin (MCH): 30 - Mean Corpuscular Hemoglobin Concentration (MCHC): 32 - Red Cell Distribution Width (RDW): 12.2 Although I suffer from B12 deficiency and receive monthly injections, my levels read B12: 480, Folate: 11, and Vitamin D: 34.6. Thyroid Stimulating Hormone (TSH) was measured at 2.1, Magnesium at 2, and Zinc at 68. However, the most peculiar findings arise from the differential counts: - Neutrophils: 85% - Lymphocytes: 10% - Monocytes: 5% - No immature cells noted This results in a Neutrophil to Lymphocyte Ratio (NLR) of 8.5%. Further tests indicated: - Total Iron Binding Capacity (TIBC): 320 - Unsaturated Iron Binding Capacity (UIBC): 297 - Iron: 23 (marked abnormal) - Transferrin Saturation: 7% (critically low, emphasized throughout my report) - Ferritin: 32 (identified as borderline) Could this elevated NLR suggest the presence of a bacterial infection despite normal WBC levels? Though this figure reflects a rise from my baseline, it’s not alarmingly high. Additionally, the transferrin saturation is extremely low; despite low iron levels and borderline ferritin, my hemoglobin remains significantly high for a menstruating woman, showing no signs of decline. Thus, I may be facing two separate issues: an early stage of iron deficiency and a bacterial infection. Alternatively, could there be an interplay between these two conditions, indicating a sharp drop in iron as opposed to a slow decline? If so, what could be causing both anomalies? Past medical diagnoses include mild Hashimoto's (with TPO levels of 36, slightly elevated at 21 upon retesting; TSH levels have never surpassed 3.5) with no current medication. Additionally, I have B12 insufficiency (with a baseline of 190-200). In terms of current medications, I take 50mg of Vyvanse for chronic fatigue, which initially helped but seems less effective lately. Regarding my iron panel, no tests had been previously conducted due to consistently normal hemoglobin levels. Finally, I also take magnesium at night to alleviate muscle spasms, though I can't recall the dosage.

Answers (1)

9/6/2025, 6:01:41 PM

OpenHealth AI

Your situation presents a complex intersection of symptoms and lab results, suggesting potential underlying issues such as iron deficiency and possibly an infection, but let’s unpack this step by step.

Main Points

1. Symptoms & Family History: Your suspected focal seizures and sensory disturbances are concerning but not definitively indicative of epilepsy, given your family's background and your physician's insights.
2. Lab Results & Potential Conditions: The peculiar hematological findings, especially the elevated Neutrophil/Lymphocyte Ratio (NLR) and low transferrin saturation, suggest possible underlying conditions.

Explanation

• NLR Meaning: An elevated NLR can indicate a response to stress or inflammation, often associated with infections, and specific bacterial infections could indeed lead to changes in these counts. Your WBC is within normal ranges, suggesting no strong acute infection but could highlight chronic inflammation or mild infection.
• Iron Deficiency: Your ferritin is borderline while transferrin saturation is very low, pointing toward an iron-deficiency state possibly exacerbating your symptoms, particularly if you have an ongoing challenge with your iron levels. Despite a normal hemoglobin, low iron reserves can impact your overall energy and health.

Next Steps

1. Monitor Symptoms:

   • Keep a symptom diary. Track episodes of phantom aromas and any associated sensations like anxiety or panic. Note any triggers or patterns in symptoms.

2. Manage Nutritional Support:

   • Increase dietary iron intake: Include more iron-rich foods (red meat, legumes, fortified cereals, leafy greens) in your diet. Pair with vitamin C sources (like citrus fruits) to enhance absorption.
   • Continue B12 injections as directed and ensure your physician monitors your levels regularly, given the ongoing deficiency.

3. Hydrate and Rest:

   • Maintain good hydration, especially if you experience episodes that feel like panic or light-headedness. Ensure you’re getting adequate sleep to support overall energy levels and recovery.

4. Follow-Up on Lab Results:

   • Discuss with your physician the possibility of re-evaluating your iron levels, thyroid function (since you have Hashimoto's), and any other necessary inflammatory markers. To address fatigue, consider asking if any adjustments to your Vyvanse dosage or type may be warranted, as its efficacy can change over time.

5. Monitor Blood Pressure and Heart Rate:

   • Given your low blood pressure and elevated heart rate, keep a record of daily readings and discuss any significant changes with your healthcare team. If you have symptoms like dizziness or fainting, share these observations promptly.

6. Consider Further Testing:

   • Explore if more comprehensive blood tests (like complete iron studies or more specific inflammatory markers) are warranted, especially since there seems to be a connection between your iron levels and the elevated NLR.

Conclusion

Your health situation may involve interconnected factors, including potential iron deficiency and inflammation or infection. By keeping a detailed journal of your symptoms and discussing these findings thoroughly with your healthcare providers, you can better manage and understand your health moving forward. You're taking proactive steps, which is crucial. Let me know if you have additional questions or need further assistance!