What else should be checked for when one is tired a lot?

What Else should be checked to find

an 'All the Time Tired'

that doesn't show up in the normal lab work?

Such as the Full Blood Panel

Hemoglobin, Hematocrit

'Retic' Ratio *

Red Blood Cell Counts *

Complete Blood Counts * *

Anemia

Falacy: if there is significant hemolysis this would be picked up on the blood count.

Not true. There can be significant hemolysis which is invisible if all you do is a standard blood count, but shows up nicely as an elevated reticulocyte count about 2.5 days after exposure. This is called compensated hemolytic anemia.

According to Robbins Pathologic Basis of Disease, 5th Edition (1994), Chapter 13 (Diseases of Red Cells and Bleeding Disorders), page 584:

"With an increased demand for blood cells in the adult, the fatty marrow may become transformed to red, active marrow. Moreover, this is accompanied by increased productive activity throughout the marrow. These adaptive changes are capable of increasing red cell production (erythropoiesis) seven- to eight-fold. Thus... such loss of red cells as may occur in hemolytic disorders produces anemia only when the marrow compensatory mechanisms are outstripped."

So a reticulocyte count might be a good screening tool for red
blood cell damage/destruction due to exposure to certain types of solvents, e.g. glycol ethers, in patients who are not so badly damaged that they can no longer replace red cells as fast as they are losing them (i.e., they still have normal red blood cell count, hemoglobin, and hematocrit).

(name withheld) looked for changes in peripheral blood and bone
marrow in solvent-exposed printers and spray painters, and found
substantial bone marrow abnormalities that were undetectable in
peripheral blood counts -- they focused on glycol ethers as a
likely suspect, but their study cohorts were also exposed to a
number of other solvents and other toxic agents. They
found a one-to-one correspondence between blood/bone marrow
abnormalities and red blood cell pyruvate kinase (PK) deficiency
in solvent-exposed workers.

[Note: I found this interesting because PK is polymorphic
among humans -- several percent of us have a variant form
of the enzyme -- and the majority of a small sample of
folks with multiple chemical sensitivities that I looked at
had altered PK activity and elevated reticulocyte counts
after solvent exposures ...]

I'm not sure how well the reticulocyte count would reflect benzene
exposure, which reportedly suppresses production of new red blood cells rather than simply killing existing red cells. A more
usual marker of "benzene poisoning" is an abnormally low lymphocyte
count.

So if anyone has helps beyond 'retic' ratio on finding the anemia which should become hemolytic anemia, but in the meantime must show up as low functioning red blood cells, I would be appreciative, as it seems to hide out from the regular tests doctors normally do ... and thus, anemia of this type is usually not found by one's doc.

extramedullary hematopoiesis: red blood cell production outside the vertebrae affecting a painter whose bones hurt & as you know painters are exposed to the ethylene glycol monobutyl ether - a source of harm considered in the above discussion. (His spine was compressed because of it, and bone marrow transplant couldn't be done in time... He became paralyzed and died not long after)

I hate to see you 'giving up your spleens' group. That is an organ which enlarges with this chemical over-exposure (2-butoxyethanol), along with gall bladder, & other organs. I think it is all related.

TSH

PSA (Men Only)

Any Questions should be referred to your doctor.

Testing Performed by: Providence Alaska Medical Center - Laboratory Services

Also ask your doctor to order this 'extra' tests

PO Box 196604, Anchorage, Alaska 99519-6604 Telephone: (907) 261-3631

Did you do some painting or cleaning with strong chemicals? Even use of 409 cleaner or Lysol tub 'n tile?

These would be sources of exposure to either diethylene glycol monobutyl ether or 2-butoxyethanol. These are pesticides per EPA - not just solvents. You can't find what the solvents are in gun cleaners, but it may be a source of exposure to one of these chemicals, too. Gulf war Syndrome may still be ongoing in the military. There have been soldiers with these effects being sent home today (more suicides than normal, as well)

Now hypothyroidism is an abnormal level for thyroid readings (low) and I hear you can be really tired from that alone (your medication is helping, so rule that out). The thyroid is part of the glandular system (endocrine system) and pesticides are known to cause endocrine disruption. You should watch for other effects. Do a study on the endocrine system.

Do you have headaches in the back of the head? Do you have a rapid heart beat some times? Do you have swollen organs ... like heart, spleen, gall bladder, testes or uterus? Do you have skin or central nervous system effects? These chemicals affect the CNS and you may have more than the 'not sleeping at night' problems. Difficulty concentrating? Depression? Change in personality to very, very agitation, even 'fly off the handle' People can have difficulty at school, at work, at home in getting along with others and sometime are ordered to Anger management classes (but that's not going to help)

For help? Since this chemical is said to cause hemolytic anemia, and since it doesn't show up right away in reduced red blood cell counts (because the bone marrow is making enough 'starts' of new red blood cells), ask your doctor to see if you have low functioning red blood cells. A 'retic' ratio (how many mature vs immature red blood cells are there) is an indication you have a type of anemia starting up

Do not ignore this fatigue. Maybe you need to see a hematologist; but if your doctor is interested, he/she could consult with one. I'd surf around to see what the gulf war syndrome vets are talking about if you have these assorted symptoms. There are some posts on discussion forums there that address this issue in recent months

I would expect acquired autoimmune hemolytic anemia, but few get the right diagnosis on the blood. The blood is a very complex organ; and if you are affected by these chemicals there will be other things 'screaming louder' like the effects to the central nervous system, and the blood is not being focused on. It should be, though. It will be the first thing damaged, and it will continue to underlie all other ailments.