Blood issues (tests, waivers, platelet count, Factor V Leiden)

[Guest pilot54321]

I got an email yesterday saying that HQ needed me to get a CBC (complete blood count) done for my FC1 to go through. I'm wondering why they need this. Didn't they do that when they took blood the first time? If there is a problem, why didn't someone catch it before it got to HQ? Regardless of the reason, I'm getting it done this Friday at Luke AFB. Is this something that could potentially cause a problem??? Thanks in advance!

[CHQ Pilot]

I wouldn't worry about it too much. I had my FC1 sent back from the SG because a Tech didn't follow the instructions and put some conflicting numbers on my form. I had to go an outside specialist who said I was completely normal and well within the limits.

If there was something wrong with the results they probably would have said what exactly was wrong. I'm going out on a limb here, but I would guess someone didn't put the right information down or a required test was not done. In my 48 hours on panic of being DQ'd, I found out it happens quite often that not everything is 100% correct when it gets to the SG. In the end, everything turned our okay and it was approved (even quicker than I thought it would!)

[ 31. March 2004, 00:31: Message edited by: CHQ Pilot ]

[Guest F16PilotMD]

I'm sure that's correct. If there was something "wrong" that they were re-checking, etc...they would just DQ you at the SG and send it back. It would be up to the local hospital to resubmit if they wanted to.

[Guest bear]

I am waiting for the results on a blood test for Factor V Leiden, a blood clotting disorder. My mother has it and my brother was recently hospitalized for a pulminary embolism and then diagnosed with factor v. The symptoms that my brother described are almost exactly like an "episode" that I had about 6 months ago. I didn't spend any time in the hospital but had to take a few days off work. Very painful!!

Anyway - question is...would this DQ me medically? Not everyone that has factor V gets blood clots - smoe are never aware they have it. I'd like to know though if it's going to get in my way. Thanks for help ~

[Guest F16PilotMD]

Have not seen this issue come up (sts) but my bet is it is DQ without waiver.

AFI48-123:

A7.18.5. Hemorrhagic states and thromboembolic disease:

A7.18.5.1. Coagulopathies.

There is nothing in the waiver guide.

[Guest Centuryair]

I have a gene that was passed down to me and it's called thalassemia minor. It does not affect me at all, but my bloodwork is not normal sometimes. I have slightly low hemaglobin and other levels in my blood. Like I said it just shows up, I am not affected in any way. I am applying for a pilot slot this year and I was wondering if anyone has ever heard of that being waived. I was able to get it waived for my initial DoDMERB for getting into ROTC. Thanks for the help.

-Scott

[DC]

I couldn't at all find the Air Force standards on this (without putting a ton of effort in anyway) but here's what the Navy has to say:

___________________________________

8.5 THALASSEMIAS

Rev APR 04

AEROMEDICAL CONCERNS: Thalassemias produce a low-grade anemia that can cause problems at altitude. Splenic enlargement and worsening of the anemia can occur under conditions of stress. The condition is much more widespread than commonly suspected.

WAIVER: viation personnel must meet the hematocrit standards previously listed. Personnel with beta thalassemia minor (heterozygous carriers – beta thalassemia trait) or with alpha thalassemia minor (1 or 2 gene loci absent) may be considered for waiver provided there are no other hemoglobinopathies present. Any anemia must be limited to a mild, microcytic anemia. Patients who have required splenectomy because of their thalassemia are disqualified from military flying.

INFORMATION REQUIRED: Establishment of the detailed diagnosis by estimation of HbA2, HbF, serum Fe and ferritin and by quantitative electrophoresis. The diagnosis of thalassemia cannot reliably be made in the face of iron deficiency, hence iron studies must be provided that document normal iron status with submission of the waiver request.

TREATMENT: N/A.

DISCUSSION: The thalassemias probably constitute the world's largest gene disorder. Beta thalassemia occurs widely in a belt extending from Southeast Asia, through India, the Middle East, the Mediterranean (as far north as Romania and Yugoslavia), and to north and west Africa. Carrier frequencies can vary from 2 to 30% in these populations. Beta thalassemia also occurs sporadically in every racial group. Splenectomy results in a greater risk of overwhelming infection and of severe malaria, which can effect an aviator’s fitness to deploy. The flight surgeon will not uncommonly make the diagnosis of thalassemia after chart review turns up a chronic, low grade microcytic anemia that does not respond to iron therapy. Homozygous beta thalassemia or deletions in more than two of the alfa chains are almost always severely symptomatic or anemic, and as such rarely make it into the military.

http://www.nomi.med.navy.mil/Text/NAMI/Wai...tm#Thalassemias

Take a multi-vitamin once a day to keep your iron levels where they should be and disclose all. That should help, if only a tiny bit. You said "thalassemia minor". That "minor" sounds promising for you (see my added emphasis above).

[Guest GGG308]

I also have thalassemia minor. I was accepted for OTS w/ a pilot slot, and during my IFC1, they discovered I had a slightly low red blood cell count. They ordered up some additional tests and discovered I had a "borderline" anemia that was a result of thalassemia minor (I had never even heard of thalassemia minor before then and certainly didn't know I had it and I had passed the DODMERB exam without anyone mentioning abnormal anything to me). The thalassemia minor wasn't a problem, but the flight doc said that he would have to submit a waiver for the anemia but that it shouldn't be a big deal since I was just barely anemic and had no symptoms of anemia (other than the tell-tale blood labs). I checked the waiver rates for AF pilots w/ anemia, and it was at 97% approval rate so I felt I had nothing to worry about. Well, my IFC1 came back disqualified from ALL flying classes last month because of the anemia waiver and I've been trying to fight it since then. It turns out that waiver's for anemia are granted ONLY to trained aircrew (per AFI 48-123 A7.18.1). That means if you don't already have wings and you have anemia then you're SOL for EVERY flight class. Well, that same AFI also gives guidelines for how low your red blood cell count (they use the hematocrit number) needs to be before the flight doc needs to consider putting in a waiver for anemia. Well, my hematocrit number has been stable for 10 years and comfortably above what the AF considers to be too low (mine is 40-41, the AFI states below 38 is where the flight doc should submit a waiver). However, the flight doc already diagnosed me with anemia, and the flight clinic refuses to resubmit my IFC1 without the anemia waiver, even though according to the AFI they never needed to do additional blood work on me in the first place. They explained to me that once they diagnosed it, they are obligated to report it, and the AFI does say that "anemia of any etiology" is disqualifing for all flying classes. I still feel that they can take it off without comprimising their integrity due to the fact that according to the AFI they didn't need to check for anemia and I have NO symptoms of anemia (and i've been certified in the altitude chamber and lived at a 7000+ altitude for several years while participating in Div I NCAA sports). I really don't know what to do now. The OTS people won't even reclassify me to a non-rated career field saying I need to REAPPLY and get accepted AGAIN to OTS w/ a non-rated job. I just found all this out in the last week, and I've been miserable since. My recommendation to you would be to have the above AFI handy when you get your IFC1, and if your flight doc says he wants to do more blood tests, do whatever you can to stop him. Once you're diagnosed with anemia, no matter how slight, that's it, you're done (at least in my case...if anyone else knows about a way to get around all this PLEASE let me know!!!!). If you want to know more about my specific case or the AFI for anemia, look at my posts from the last few weeks (or feel free to ask whatever). Sorry for the bad news, and I hope they draw good blood when you go for your IFC1. Oh, and after I was DQed, I researched ways to hide the anemia in case I could get new blood work done. If they look at the actual blood cells, it's impossible to hide, because anemia associated w/ thalassemia minor are typically smaller in size (microcytic) than normal blood cells and you just can't control how big your cells are (well I suppose while you are in bed at night you could try chanting to your bone marrow, "make normal sized blood cells, make normal sized blood cells" over and over again until you fall asleep). BUT, I don't think they look at your blood cells during an IFC1 unless you get back unusual lab results. I was caught because my hematocrit was slightly low and you CAN control that to an extent. Heavy cardio can increase the hematocrit slightly. The hematocrit is just the percentage of your blood that is made up of red blood cells. If you force your body to go into oxygen debt (through heavy cardio) on a routine basis then your body will compensate in a variety ways to include increasing the production of red blood cells. Smoking can accelerate this. Another way to raise your hematocrit is to be slightly dehydrated when you go in for your blood work. When you are dehydrated your blood volume goes down but your red blood cell count stays the same meaning a higher hematocrit number. I'd be careful with that though, because if you are too dehydrated your hematocrit number will go ABOVE the normal range and then they'll do additional lab work anyways. Well, this was WAY long, and probably the only one who read it to the end was you Centuryair. I hope it helps, I hope you get your pilot slot, and I hope I get to wear wings myself someday. I'm still fighting this and will apply for an exception to policy if that's what it's going to take. Take care, -Gil

[Guest hokie00]

Hey Gil, man... I dont know what to say. I'm sorry this happened to you. This is one of the most gut wrenching stories I heard.

What I don't understand is that shouldn't flight docs(and I guess most do) try to go to bat for the OTS candidates? Unless the doc feels like he is violating ethical standards, I think he needs to exercise more discretion.

In your case, you played NCAA Div 1 sports and are healthy as an ox and the kicker is that your red cell level isn't as low as the level required for a waiver. If 97% of existing trained crews get waivers and go about their career and flying duties without a problem, I dont see why a healthy young guy who even played NCAA sports shouldnt get the green light. Of course I'm not a doctor and I don't know what reasoning your flight doc had for concluding you needed a waiver, but I think it is a quantified fact that your condition doesn't pose a threat to flying capabilites. (since 97% of existing crews get waivers).

But I believe there is a way where there is a will. I had to apply to OTS 3 times myself and I ended up wasting almost 2 years due to silly recruiter errors. But you know, we might think we are wasting time and getting nowhere, but the truth is that god doesnt make mistakes and he doesnt waste times. Keep your chin up and keep a positive attitude!

(If anyone is offended by my religious comment, I apologize. But thats what helped me get through tough times personally)

[DC]

Though I do understand why you looked it up -- I too looked up ways to decrease blood pressure after they made me re-take that part of the physical, apparently for no reason because the 5-day average I had way well below the levels considered by the AF to be hypertension and none of the techniques for lowering blood pressure work except over a long period of time -- Despite the fact that hiding a medical condition that would potentially disqualify you is just plain wrong you will absolutely not want to do this because you ALREADY have a waiver for your condition because of your DoDMERB.

Good luck.

[Whitman]

Flight Doc,

A friend of mine at my ROTC detachment was told by the commander that she can't fly b/c of the blood clot in her arm/upper chest.

She got the blood clot after getting her wisdom teeth taken out...the nurse didn't clear the needle b/f giving her the IV.

Is this DQ? She's on cumadin (blood thinner) right now. The blood clot has deteriorated for the most part but not completely gone yet. What are your thoughts?

[Guest F16PilotMD]

Her commander is wrong! It is a DQ condition but it is waiverable.

The reg says:

AFI48-123 A2.7.1.19. Deep venous thrombosis with repeated attacks requiring treatment or prophylaxis, or pulmonary

embolus.

The waiver guide:

AFPAM-48-132

Updated-2/97

By LtCol. Benjamin

CONDITION: DEEP VENOUS THROMBOSISPULMONARY EMBOLISM

I. Overview. Venous thrombosis occur in approximately 5 million North Americans each year, resulting in approximately 600,000 cases of pulmonary embolism. When pulmonary embolism is recognized and treated, mortality rates are around 8%, but when untreated, mortality rates are as high as 30%. Thrombosis begins as a result of a combination of factors outlined by Virchow: stasis, injury to venous intima, and alterations in the coagulation-fibrinolytic system. Most commonly the thrombosis will begin in the veins of the calf. However when limited to the calf vessels, there is little concern for clinically significant embolization. If left untreated 20% will propagate and involve the proximal venous system and 50% of those will embolize to the lungs. Clinical diagnosis of pulmonary embolism has always been difficult and often unrecognized. In one series only 28% of massive and submassive fatal pulmonary embolisms were recognized before death.

Risk factors for thromboembolism include: venous stasis due to prolonged immobilization, debilitating medical conditions such as heart failure, obesity, varicose veins, anesthesia and age (>65); endothelial injury due to surgery, trauma, venous catheter wires and previous thromboembolic events; hypercoagulable states due to malignant disease, high estrogen states whether exogenous or endogenous, inflammatory bowel disease and hematological disorders such as polycythemia, leukocytosis, thrombocytosis, antithrombin III deficiency, antiphospholipid syndrome, protein C or S deficiency, and activated protein C resistance.

Symptoms for pulmonary embolism are not specific, although the diagnosis is unlikely in the absence of dyspnea, tachypnea and predisposing conditions for a thromboembolic event. Initial treatment with heparin for 10 days is used to stabilize the clot. Warfarin therapy is then used for 6 months, longer for repeat thrombotic episodes. Recent studies have shown that a shorter duration of warfarin therapy of 6 weeks is associated with higher rate of recurrence (OR = 2.1).

II. Aeromedical Concerns. Acute symptoms of pain and swelling from thrombophlebitis may be distracting and impair lower extremity function. Pulmonary embolism will usually cause symptoms of dyspnea and chest pain along with a variety of other non-specific symptoms. Hypoxia and possible cardiac complications may be incapacitating. During treatment with anticoagulants or thrombolytics the chief complication is bleeding. The aviator is also at risk from any underlying condition which may have predisposed to the thromboembolic event, such as a malignant disease or a clotting disorder.

III. Information Required for Waiver Submission. Waiver will be considered for a single episode of deep venous thrombosis with or without pulmonary embolism provided there is full recovery and a minimum of 6 months of warfarin has been completed. A normal exercise tolerance test and a normal pulmonary function test should be submitted. Appropriate evaluation should also be completed with the workup determined by the clinical setting. For instance, the aviator who has an embolic event following knee surgery needs no further search for etiology, while the unexplained case of embolism would require a hypercoagulability workup at a minimum, along with ruling out any malignancies suggested by age, habits, history, or exam. Waiver will not be considered for residual pulmonary hypertension, need for prolonged anticoagulation, insertion of a vena cava filter device or any surgical procedure to the vena cava.

IV. Waiver Considerations. All patients with single episodes of deep venous thrombosis and 87% of those with pulmonary embolism have received waivers.

She should push this issue if she fits the bill in the above waiver guide.

[Guest speed_demon1182]

Flight Doc:

I am a senior at Embry-Riddle, a pilot, and in the AFROTC program there. This past September I developed a blot clot (DVT) which became a case of pulmonary embolism by the time it was diagnosed. The cause was Factor V heterozygous mutation, oral contraceptives, and a road trip near the end of August. As soon as I informed the officers at my detachment of what happened they gave the news to HQ and now I have lost my NAV slot and been disenrolled from ROTC. I am currently in an appeal with the SG at AETC. I have letters and test documentation from hemotologists and pulmonologists in the area stating my risk factor will go back to 3% once I'm off coumadin at the end of March and as long as I stay away from all oral contraceptives. I'm not receiving any support from key personnel at my det. and I can't seem to find anyone who can give me any advice on how to win this appeal. I've read the regs online but I could use a "lamens terms" veiw on them.

Any advice you can give me would be very appreciative. Also, I have been tested for all other forms of genetic abnormalities leading to blood clots and every test but the Factor V came back negative. I'm a member of the track and XC team at my college and an avid health person overall. I maxed out every PFT in the last 3 years. Flying for the Air Force has been my goal for the past 5 years and I really can't let that go without a fight.

Thank you for your time,

Amanda

[Guest F16PilotMD]

I'm not a hematologist but...how can you ever come off Coumadin if you have Factor V? I know you don't know the answer to that but the bottom line is this--you have a propensity to form clots and you had the worst possible complication of this disorder--a pulmonary embolus. There is no going back from here so far as the USAF is concerned. They will not accept that risk and your odds are terrible for future problems.

If you've read any of my replies you know I'm all for pushing for waives, etc, but in this case I see no way for you to come in the military.

[capt4fans]

I'm hoping someone here can help me find out about a possible problem I have.

Here's the background, my dad was a pilot in the Air Force, and has been retired for quite a while now. He recently had shoulder surgery, and developed a blood clot after the surgery.

It took forever to try and get his clot taken care of, and it's never really gone away. Along the way in his treatment, he had a blood test and discovered he has what is called Factor V Leiden gene mutation. Basicly it means he's at a higher risk for blood clots than the normal person.

Here's my problem. It's hereditary. And I may have it as well. Well, as luck would have it, I just got my pilot wings, and am worried that if I do have this blood problem/gene mutation, it may be a disqualifer and possibly could end my flying career right as it starts.

Does anyone know if this blood disorder is a grounding issue? Is there anything in the regs about it. I haven't been tested, and I'm afraid to since it might end my flying career.

I'd apprecite any advice that someone might have. Thanks.

[Karl Hungus]

I highly doubt that any basic blood test would detect your condition. So I doubt they'd even find out about it unless you told a flight doc. So don't tell a flight doc.

[Guest awfltdoc]

The mutation increases the risk of thromboembolic disease (deep vein thrombosis and pulmonary embolus are the most worrisome). Other things you should know is that you should not smoke, and be carefull about sitting for prolonged periods of time (recommend walking around every couple hours to keep blood from pooling in the lower extremities), and that hormonal birth control can increase the risk.

These are the reasons to talk to your flight surgeon.

Having the mutation (picking it up on the blood test) is not disqualifying. I have had two aviators in the past year with this mutation and I talk to them and explain the risks. I do not DNIF for this.

BTW, Having the mutation does not guaruntee you will get a blood clot.

[capt4fans]

Yeah, I know all the things that you told me about moving around every few hours and the like.

Thanks for the help. That puts my mind at ease that I can go talk to the flight doc about it without having to turn in my wings.

And RedCross.....thanks for nothing.....your advice was less than worthless. I would have gotten better advice had I asked my 7 month old the same question.

Edited March 16, 2007 by capt4fans

[Guest Neb_16]

I am a sophmore in college. 4.0 gpa, 90s across the board on the AFOQT, extensive flight experience (both VRF and IRF). I am in ROTC and have wanted to fly for the Air Force for all of my life. I believe I have a good chance of getting a pilot slot, but it is the flight class I medical that has me worried. My platelet count has been around 80,000 to 100,000 ever since I can remember. (125,000 to 400,000 is normal). According to http://usmilitary.about.com/od/airforce/l/blflymenu.htm, platelet counts of less that 100,000 should be evaluated? What does this mean? I do not have any type of blood disease or anything,just a lower platelet count than "normal". My doctor has looked into it and says it is not a big deal at all and is most likely just a genetic thing as my father also has low platelets. Is this disquallifying for the air force pilot class medical? I can't find anything about this. Thanks.

Edited September 11, 2009 by Neb_16

[JakeFSU]

Definitely an old thread, but thought someone might shed some light on my recent blood work. So, I had some blood work done and I was looking over the results and comparing to what is considered normal. My hematocrit came back at 39.3 (slightly below normal) and my hemoglobin was 13 (also slightly below normal). Looking at the AFI 48-123, anything under 40 requires further blood work and a waiver. But it looks like waivers are only considered for trained airmen. Until yesterday, I didn't think I'd have any problems getting my FC1, obviously now I'm not feeling as confident. Anyone have anything similar? Or know how I can increase my hematocrit by .7!?!?

I'm expecting to go to Wright-Patt March/April time frame. Appreciate any advice/information.

[Lineback]

I'm an active duty pilot select (I'm currently an active duty SSgt)...I had an OTS date for BOT 13-01 (starts 24 July 2012), but my FC1 was pushed back to me because of bloodwork. Apparently my Hemoglobin level is 17.3 and my Hematocrit is 58.1. Has anybody had problems with elevated numbers like this?

I've been reffered to a hematologist to try and figure out what is going on. I'm thinking about donating blood in an attempt to get these numbers down...anyone know anything about this?

[Guest]

I'm an active duty pilot select (I'm currently an active duty SSgt)...I had an OTS date for BOT 13-01 (starts 24 July 2012), but my FC1 was pushed back to me because of bloodwork. Apparently my Hemoglobin level is 17.3 and my Hematocrit is 58.1. Has anybody had problems with elevated numbers like this?

I've been reffered to a hematologist to try and figure out what is going on. I'm thinking about donating blood in an attempt to get these numbers down...anyone know anything about this?

You could be dehydrated. Drinking a lot of fluids could help these numbers. Donating blood then drinking lots of water over 3 days MIGHT help. Donating Plasma could have the opposite effect. However, know that donating blood will not solve the long term problem of recurrent CBC's over your flying career. I recommend you drink plenty, then go to the hematologist. The specialists' diagnosis is going to carry the most weight.

[sab245]

So... I hate to (re)necro a thread, but I think I'm going to. 

I'm an AFROTC cadet at Yale, or at least I was one up until a month ago. I had some routine blood work done (for vitamin deficiency, omega-3 level, etc). Inadvertently, I was told I had Factor V Leiden, mentioned above^. I reported this to my det, didn't think much of it, but then cam back as Disqualification without potential for a waiver. I have been scrambling to find a solution to this mess (even trying to get the ETP process going, in vain). 

Is factor v leiden (heterozygously inherited) supposed to be PDQ? All the Wright Pat waier guides seem to show it as a 'reversible risk factor' with AETC waiver potential. So, what gives? Was my DQ a mistake possibly?

 

Thanks

[deaddebate]

words

It is waive-able for straight Accession (non-fly). It is a hard DQ for flying with no waiver potential.

[sab245]

Never said thank you deaddebate - so ... thank you for your reply last month! I appreciate it.

 

It turns out that it was disqualifying with no chance for waiver. This came straight out of the horse's mouth. Maybe you were just thinking of some other thrombophilia, deaddebate? It definitely ended my AFROTC career and a rebuttal failed as well. I also reached out to A/NROTC and was told the same thing, any thoughts on why that would be the case?  

 

I have some questions on ETP's, but don't want to derail this thread in case someone else wants to add something. So I just posted those on the ETP thread here, please help me out if you can, thanks.