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Hematology/Blood work question

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QUESTION: I had a large pericardial efussion 2 years ago.  1 liter of blood was drained 3 days later, it started to reacumulate and I was in tampenade.  I was transferred to a hospital with thoractic surgeons. I had a pericardial window. A biopsy of the pericardium showed both chronic and acute inflammation.  Since the efussion, sed rate, C-reactive protein and IGE were elevated and I had a positive ANA.  My MCV and MCH have been low.  Prior to the effusion, blood work, heart rate and blood pressure were very good.  Since the efussion, I had tachycardia, elevated blood pressure and palpartions. Verapamil has resolved those symptoms.  I have been taking plaquenil for a year which normalized my sed rate and C-reactive protein. My ANA is lower but still elevated. My complement 4 is elevated and MCV and MCH are low. Could the low MCV and MCH mean that the pericardium continues to slowly secrete blood?  Do some people have chronic mild pericarditis?  Do windows ever close up, putting the person at risk for another efussion?

ANSWER: Stacy,
Sorry for the late reply.
No. Low MCH n MCV is not related to pericardial effusion. Because the pericardial fluid is not complete blood. Its a clear straw colored fluid secreted by pericardium. Pericardial fluid doesnt contain RBC. So decreased MCV and MCH is not related to that. But Its quite possible its due to the connective tissue disorder you are having. Since your ANA, ESR are elevated, it indicates connective tissue disorders like, rhematoid arthritis, scleroderma, polyarteritis nodosa, sjogren's etc. You are taking plaquenil, it should relieve the inflammation. But you may need supplements to increase MCV and MCH. People with connective tissue disorders can develop pericarditis recurrently. The idea of having a pericardial window is to drain excess pericardial fluid which is being secreted abnormally. So a pericardial window is good for you. It should not get closed.

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---------- FOLLOW-UP ----------

QUESTION: When the efussion was drained, I was told that they drained BLOOD.  Bloodwork done a month after they drained the blood showed that I was severly aenimic.  The doctor said that the anemia was most likely from the large effusion.  Is it uncommon to drain blood? Could this mean that I am continuing to leak blood?

Answer
Stacy,
Its quite possible that in pericaridal effusion, the fluid collected could be blood, pus etc. But since you said there was chronic and acute inflammation, I assumed the fluid was pericardial fluid. Normally collection of blood in pericardial sac happens when there is trauma. Still considering it was blood, since they had created pericardial window, it should drain and return to circulation. Its quite possible that the severity of your connective tissue disorder might be affecting the RBC. In medical science blood is considered as a connective tissue. So in connective tissue disorders MCV, MCH variation is seen. If you are really worried, its better to get echocardiography done. If required pericardiocentesis could be performed and the fluid can be examined for blood.


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