Hello,

Thank you for asking your query at DoctorSpring.

I would require some additional information from you so that I can provide my best learned opinion.

1. I understand you had a high Haemoglobin / Haematocrit value in the blood test. Do you happen to remember or have the records to say what the exact values are?

2. The Bilirubin values are 3 mg/dl. Do you know what fraction is the direct and what fraction is the indirect Bilirubin level?

3. Do you have any symptoms related to sleep apnoea? As in snoring, feeling sleepy during days time, non-refreshing sleep etc ?

4. Do you have any of these symptoms? – Weight loss (documented), back pain, abdominal pain, fever, nausea or vomiting?

5. Regarding the polyps, Have you had an ENT surgeons opinion in this matter ?

Thank you 

Thank you for the addition details you have provided. 

1. Even though Nasal polyps is not my field of expertise,  I would recommend the surgical removal of the Polyps. You seems to have some features of sleep apnoea (more of  an airflow obstruction than apnoea) and you will possibly benefit from polypectomy. Good to know you are getting it done soon.

2. There are no features suggestive of a pancreatic cancer. (You have not mentioned about any weight loss. So I assume there is no major weight loss). The pain which responds to PPI is definitely ulcer related. The high bilirubin is also not related to any pancreatic issue. If that was the case there would be predominant symptoms and other liver function tests would show an ‘obstructive pattern’.

3. The high bilirubin and Haematocrit could be soft finding. But needs further evaluation. The high Bilirubin could be due to increased break down of the Haemoglobin. So a measurement of direct and indirect fractions will give idea in this regard.

The high Haematocrit / Hb could be due to a lot of reasons. Sometimes it could be just a normal manifestation, or caused by conditions such as high altitude. In rare cases tumours in the liver or kidney can cause this (due to increased production of erythropoietin). Being said that it does not mean the raised Hb is suggestive of a tumour. You will need a set of investigations.

1. Repeat complete blood count, including MCV and MCH

2. Ultrasound of Abdomen and Kidneys

3. Urine Microscopy for RBCs

4. S. Bilirubin with Direct and Indirect fractions

5. Electrolytes.

You should discuss these options with your Doctor. I hope I could give you a general direction on how to proceed further. These tests are simple and easily available. Once it is done and possible conditions are ruled out this will give you good peace of mind.

Hope this helps

Please feel free to ask followup questions

Thank you

Hello,

You will require some more blood investigations. 

But do not worry, there nothing is grossly abnormal. 

You may need a LDH, Peripheral Smear and Coomb's test. 

Gilbert Syndrome is a diagnostic possibility. Glad that you are having a Gastroenterologist consultation. He/She will guide you in the right direction. 

Thank you