Illustration by Dola Sun
I keep asking my cousins about their blood. I ’ve already exhausted my siblings. Who has low platelets in this family? Speak up now! I need to see if there’s a genetic trail.
My blood has been coming back with low platelets for at least 20 years. The normal range is something like 150,000 to 300,000 and mine have long hovered around 100,000. In my most recent bloodwork, my white blood cell count came back a bit low, too. (A little bit, to be clear.) My B-12 count was also at the low end of acceptable.
My doctor is a cautious type, which I appreciate since I’ve now reached 50, The Age of Most Risk Factors. At my annual physical this year, she tells me she wants me to start taking B-12 supplements to prevent a certain kind of anemia. I already take C and D, so I have no problem adding onto the alphabet.
There’s another thing, though. She says she wants me to see a hematologist about all these low counts.
“But I feel fine,” I say. “I ran five miles this morning.” “Your counts aren’t normal,” she says. “They haven’t been normal forever though!” “That’s why you should see someone.”
It’s not an exaggeration to say that I hrmph. I scoff. I sigh. I don’t want to see someone. The $100 co-pay. The time involved. The waste of resources. But it’s hard to be petulant in a hospital gown with a broken tie. Plus, what if she’s right and there is something truly wrong?
Later that week at my brother Tony’s birthday dinner at Rio Grande in Newport, I demand to know about everyone’s blood. It’s not the best conversation to have when you’re dipping chips in red, gloopy salsa. “One of you must have low something in your blood,” I say to my four siblings who are there.
“Oh, try Claire! I think she said something about a blood thing a while ago,” says my sister Laura.
I text my out-of-town sister the next day. Through a long thread of texts, she tells me that 15 or so years ago her doctor also made her see a hematologist for a lowish white blood cell count and her sometimes-low platelets, even though she felt fine and was running ultramarathons at the time.
She wound up having a bone marrow biopsy. It all came back normal. She tells me that after all of that—a bone marrow biopsy was not fun—the doctor said she was probably just an anomaly. Who doesn’t love to hear that from their doctor? Oops, you’re actually great, but here’s the bill!
We agree that it could be genetic. The low-platelet-sisters! The ones who do not have cancer, but instead just this silly quirk!
To trace which side of the family the condition might originate from, I start texting cousins. First I ask a cousin on my dad’s side. Nada. On my mom’s side, I’ve long been bothering my cousin, Steve—a pediatrician in Houston—with my medical questions. What’s one more? Tell me about everyone’s blood!
He responds that when his brother, Joe, was a baby, like 60 years ago, he had a red blood cell condition and had to have his spleen removed. But he was fine after that. My cousin Joe is a literal Texas rancher (at least on the weekends) and is living his best life, stepping over snakes and tending to cattle. Yay for spleen removal that cures things! But not helpful to me.
Then I remember I am the keeper of my mother’s MyChart. I scan her bloodwork. Jackpot! She also has lowish platelets! Does it matter that she’s 89? A quick Google search tells me that platelets do decline with age, though hers still hover at the lower end, even for her age. And she is the healthiest 89-year-old I know.
Still, I make the appointment with the hematologist because that’s the responsible thing to do. I fill out the pre-appointment paperwork, checking “no” over and over again to the long list of symptoms. I check “yes” on only two. Allergies? I mean, hello, pollen. Anxiety? I have teenagers.
Then I wait for the appointment, every day hoping that my blood isn’t going to betray me. That I merely have a genetic quirk of no real consequence, like my cloverleaf tongue and my smelly asparagus pee.
Genetics are a gift and a curse. I recently worked on a whole section of a children’s hospital website, writing pages of content about rare genetic diseases. I learned about errors in genes that get passed down, where enzymes don’t work as they should. Some are treatable. Others are absolutely devastating, often because a parent is the carrier of a defective gene and doesn’t know it. It’s all such strange and unfair math. Even healthy babies who have healthy childhoods can grow up to find a familial disease lurking, waiting for them. Oh, the places you’ll go!
Case in point: My paternal grandfather died in 1942 at the age of 40. Though he was fit and seemed otherwise healthy, he had crazy high blood pressure. My dad inherited whatever gene caused that. But there was medicine for high blood pressure by the time his readings started edging up. He stayed healthy and fit until he developed dementia in his 70s, dying in 2013. Was that genetic, too? Or was it because he worked in a lab with chemicals for years?
If only we could read our blood like we read maps. Come to think of it, maybe that’s what all those blood tests are. The CBC, the CMP, and the lipid panels all show the highways and byways in the form of disease markers, irregularities, and deficiencies, pointing at the suggested routes you should take. High triglycerides? Take the express lane to Statin-ville. Low cholesterol? Go ahead and enjoy the scenic route. A1C not favorable? Cancel the vacation to Candyland.
Our blood numbers plot us along sweeping epidemiological curves, but our blood stories give us hints, too. For example, there is a fair amount of alcoholism dating back through the generations of my family, and I had a brother who died 15 years ago from issues related to alcoholism and substance use. So when I found myself drinking a glass of wine every night some years back just to wind down, it hit me one day that it wasn’t the best choice.
It was remarkably easy to just stop, so I’m lucky. Maybe that means it was never in my blood. Either way, I’d rather get off the toll road.
Right away, I like my hematologist. And a little part of me feels grown up, laying claim to having a hematologist. Starting a sentence with “My hematologist says…” commands something. Confusion, most likely, because the general public mostly doesn’t know who that is.
Anyway, he’s a cool guy. Very relaxed. He asks what brings me in. “Do you have time for a family story?” I respond. I tell him all the things about not being able to give blood most of my adult life and my sister’s ordeal with the unnecessary biopsy and, Look, here is a picture of my mother’s MyChart test results page. Twinsies!
He listens and nods a lot. He asks about symptoms. I have none. He asks if my kids have had bloodwork, and I remember that my 14-year-old daughter had blood drawn last year. I am the MyChart Madame! I pull up hers and, bam, she’s my low platelet girl. She even has my low neutrophils. I couldn’t be prouder.
“You, your mother, your daughter, and your sister, you live down here,” he says, gesturing with his hand. “But that is normal for you.” If I really wanted definitive answers, I could spend lots of money and get more testing to know exactly what’s happening with my genes. “But I wouldn’t do that,” he says, smiling.
He does want me to keep taking B-12, which is fine by me. There’s so much more I want to ask him. He’s a blood expert, after all. Tell me how it all works, I want to say. Explain how blood ties us to our ancestors and is so unfair for so many. But I don’t, because I’m sure my co-pay doesn’t cover a philosophical discussion.
As I leave, I’m acutely aware of being the easy patient. The one who gets the good news and is able to walk worry-free down the spiral steps of the big cancer center and into the sunlit atrium.
I wonder how many people got bad news here today. Who has just learned they carry the BRCA genes? Whose low blood counts aren’t just a thing of curiosity but a signal that they’ll spend the next few years fighting? I feel grateful and sad and like I want to give my blood a hug, every single stingy platelet of it.
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