instruction: hello doctor I am 40 years old 20 years back I was diagnosed with severe aplastic anemia idiopathic which was treated with at with prednisone cyclosporine it took a good year to have a complete recovery but it came back to 100 I have always lived a bit in the fear of myelodysplasia but 23 years later no issues other than cholesterol and high blood pressure I am being follow by a family doctor and getting blood counts every month but my last hematologist consultation was a very long time ago and while my doctor is fantastic I know that knowledge of hematology is complex I am tracking by blood counts for the last 12 years in the last years I develop my own concerns around some numbers that seems to trend on lower side first is erythrocyte which are 3 now 13 years back I was consistently around 8 but my last blood count was 3 but after years it has never been above 5 I do not know if this is significant or not but I know that our reference is 7 of the lower value average 13 bloods test would be 53 my hemoglobin is at 132 now my average would be 141 so the difference is not high but I still wonder about if it is significant finally hematocrit at 4 right under the low level it would average out a 41 now a new contender appeared in the outside of normal ranges and its the granulocytes immature at 04 reference is 03 10e9 platelet are doing great with 183 so no challenges here so in a way all of these number are very close to the lower normal I guess I am trying to figure out if I should investigate this further I will see my doctor in a few weeks for a follow up but in our last appointment she did not see any issues there in a way I get her point but I am not sure when I should start asking for an hematologist reference as for current medication I am on rosuvastatin 20mg ibersartan 300mg for a few years already but new to me is allopurinol 200mg for now still working on balance my question is really about if the number above can indicate a trend or not I understand the body change as we are getting older but I would like some opinion on this
output: hi I reviewed all the documents you attached attachment removed to protect patient identity I can feel your concern as I have closely followed many aplastic patients before so the fear or concern you have is genuine but I am happy to say that your abc is wonderful I am not bothered at all the slight decline may be due to other reasons sometimes diet nutrition laboratory variation etc I would advise you not to worry and just get a routine laboratory check as per your primary physician like months or so you completely recovered the only advice is to make sure when you start any new drug or take ot drugs herbal medications make sure they do not have side effects of bone marrow suppression so just be cautious rest you are doing good please text me any other concerns if you have