Expert: Claes-Gustaf Nordquist, M.D. - 8/14/2008

Question
Dear Dr.
I had lobular breast cancer, 2 tumors, grade 1 (borderline grade 2) with (2) surgeries to remove tumors and lymph nodes  followed by chemotherapy and radiation in 2005.  

Within the last 6 to 12 months I have had EXTREME fatigue, side stich/pain left side under rib cage, more frequent diarrhea, mid-back pain, pain in ankles when I get up after laying down, and a feeling of fullness. I have also since the treatments developed snoring and gained weight (18 lbs.) I can't seem to lose.

Recent CBC:      Last yr. CBC
WBC      6.9         7.3
LY       43.4       38.7     
MO       5.1         3.6
GR       51.5       57.7
LY#      3.0        2.8     1.8 previous yr
MO#      0.4        0.3  
GR#      3.6        4.2
RBC      4.87       4.61
Hgb      13.9       13.9
Hct      43         41.8
MCV     88.4        98.7   lowest value yet
MCH     28.5        30.2   lowest value yet
MCHC    32.2        33.3   lowest value yet
RDW     13.1        13.6
Plt     194         192 baseline is 234-245, was 228 prior  yr
MPV      8.4        8.6

The MCHC, MCV, and MCH are at the lowest points since before the cancer.  WBC is dropping with increasing LY, MO, LY#, MO#, and decreasing GR.  Hct is increasing (Only higher points were during radiation). MO# is at highest point since  before the cancer, and platlets are at lowest point these past 2 years.

Could this be an indication of latent iron deficiency?  What about any issues with bones or spleen? The fatigue is affecting daily life - difficult to get through a day, work is becoming difficult.  Any ideas?  

Answer
At the moment and before there is no sure anemia or any certain sign of iron deficiency. There is also no obvious pathology in the levels you have presented (but there are no blood iron levels etc. presented either). I doubt too that your symptoms have anything to do with your post surgical radiation therapy and chemo therapy. In fact the lab. tests you have presented do not give any obvious cause either. But with such troublesome symptoms there is cause for concern so a vigorous investigation should be started to find the cause. For that you have to consult your local drs. Good luck!