What to make of slightly below normal blood test results

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Hello- I saw my physician last week for some vague symptoms of fatigue, hair loss and headaches.  Most of my resulting labs came back normal , though 3 readings were ever so slightly below the assigned reference range. These were a serum calcium of 8.9 (normal range 9.1 – 10.6 mg/dL), red blood cell count of 3.8 (normal range 4.0 - 5.3 M/uL) and hemoglobin 11.9 (normal range 12.0 - 16.0 gm/dL).  

I received these results through an automated on-line system, with no commentary from my doctor.   Is it safe to assume that since these results are so borderline, there is no cause for concern?  For reference, I am a 40 year old female in normally good health.  I am also a long distance runner and have definitely been feeling more fatigued that usual during runs, which was one of my reasons for getting my blood worked up.  Thanks in advance for any thoughts.

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  • Posted


    I appreciate your concern, 

    Your serum calcium level is slightly below normal, but it's nothing to be worried about. Usually, after 40 men and women tend to be at an increased risk of developing osteomalacia and osteoporosis due to hormonal drops. 

    I would advise adding foods with high calcium content:

    Yogurt, cow's milk, almond milk, sory or rice milk, orange fortified calcium juice, cheddar cheese, broccoli. Try to stay away from regular milk, even if it's 2% reduced fat milk, go with almond or soy milk as they are much healthier. 

    You can also start on some calcium supplements just make sure to buy the Calcium malate chelate or calcium glycinate chelate instead of calcium carbonate or calcium citrate as those have poor absorption rate. 

    Because Calcium inhibits magnesium absorption and magnesium is such an important electrolyte in our body, I would advise you to take calcium with magnesium in a 2:1 or 3:1 ratio. You look up Osteoforce on Amazon. Same thing, magnesium chelate instead of magnesium oxide. 

    Now, you're slightly anemic which would explain your fatigue since hemoglobin carries oxygen to the tissues. 

    I just don't know what kind of anemia you have. Do you mind posting your MCV, MCH, MCHC and RDW values so that I point you in the right direction? 


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    • Posted

      Thanks so much for the information.  Ironically, I do feel that I eat a diet fairly high in calcium, and usually have a glass of almond milk and 2 Greek yogurts per day.   I have no issue adding a calcium supplement, however, as that is a very easy fix.

      The additional blood work results are as follows:  MCV - 97.1, MCH - 31.3, MCHC 32.2 and RDWSD 34.8.  

      My physician has since messaged me to say that I am "borderline anemic" and should add a multivitamin with iron to my diet, although I have been taking a vitamin that contains 18 mg of iron for years and year.  Not sure if I should add in an additional iron supplement, and will have to contact her again.  

      Thanks so much for your reply! 

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    • Posted

      Thank you for the quick reply. 

      I have forgotten to ask you if you've recently experienced any trauma, bleeding, heavier menstrual cycle? As these can result in decreased RBC. 

      Thank you for providing me with your lab values. It would appear that you are more likely running low on Vitamin B12 and Folate rather than iron. If you were iron deficient or running low on iron storage, your MCV, MCH, and MCHC would all be decreased. Instead your MCH and MCHC are both normal and your MCV is close to borderline. People with vitamin B12 or Folate deficiency will have increase RBC size (expressed in MCV or mean corpuscal volume) because Folate and vitamin B12 play a role in completing RBC formation. If there is deficiency, RBC will remain in the bone marrow and continue to enlarge until folate or vit. b12 arrive to complete the cell. 

      With that said, it wouldn't be a bad idea to check you vit b12 levels. In either case, however, I would eat foods higher in vit b12. 

      If you're already eating food that's high in calcium, I wouldn't necessarily recommend adding a calcium supplement, especially since you don't seem to be at a high risk for calcium disorders. 

      Have you ever checked your Vitamin D levels? Vitamin D deficiency can result in decreased calcium levels. If you've never had the blood work, I would suggest to just get it done, as many people tend to deficient in this vitamin. Then you can add some vitamin d to you diet or start on a supplement. 

      In conclusioin,

      Add some Vit B12 to your diet (or supplement)

      Add vit d to your diet (or supplement) 

      Continue to eat healthy and exercise. Nothing major here, you seem like you know how to take care of yourself. 


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  • Posted

    The all three of these results are most likely due to a dip in Vitamin D. Always happens at this time of year in the northern hemisphere, because of less sunlight. Supplements are available, or you can buy white mushrooms and leave them in sunlight for an hour, and eat them right afterwards. 
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