Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Psoriatic Arthritis and Taking Methotrexate: Blood Work Comments[31][F], 5'2" 90 lbs, white and Hispanic, biologic taken, no longer taking Methotrexate with psoriatic arthritis. No drinking or smoking.My rheumatologist is taking me off Methotrexate due to my blood work, in conjunction with me feeling absolutely awful.Can a doctor please explain why those comments on the two blood results were written? Is it that serious? Meaning--my doctor wants me to take a repeat. What is concerning?I attached the photos w/ Imgur:https://imgur.com/a/FDmJ7A0"RBC01 3.49 Low 3.62 07/23/2021 x10E6/uL 3.77-5.28 Macrocytes present. Anisocytosis present."" Neutrophils (Absolute) 01 1.0 Low "" Alkaline Phosphatase01 128 High 76* 07/23/2021 IU/L 44-121 AST (SGOT) 01 70 High 29 07/23/2021 IU/L 0-4 ": Hematology Comments: Verified by microscopic examination". ### Response: Youve got a macrocytic anemia, likely due to the methotrexate causing a folate deficiency basically the blood cells are bigger than normal and not developing properly.The anisocytosis just means you have a variety of different sized RBCs, meaning its likely that you are within 90 days of when the assumed folate deficiency started - blood cells live on average about 90 days so you either have a mild deficiency or its somewhat new.Neutrophils can be low for many reasons, its not at a super worrisome level but couple with the anemia its likely partially due to one of the multiple mechanisms of immune suppression from methotrexate.Alk phos/ALT/AST are liver function tests, its just saying theyre slightly elevated. Overall not super worrisome levels but again likely due to cytotoxic effects from methotrexate.Its more so they dont want you to GET bad rather than the labs ARE bad. They are borderline right now but when you have a known drug causing it, you want to stop it sooner than later. They are likely just recheckingnit to make sure they dont need to do further intervention to prevent worsening effects and ensure your body is recovering before they would try an alternative therapy or restart the current therapy if absolutely needed.Definitely a conversation to have with them for more details, not a rheumatologist so I dont know all the cytotoxic effects of methotrexate off the top of my head..