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It’s a woman and she is young. 30 maybe and a D.O. not an MD. Not sure if that makes a difference.
No history that I know would contribute except menstruation. Haven’t had any colonoscopies yet. But why wasn’t I ever anemic in the past? Things were trending down in 2022 and the Dr then didn’t do anything so I switched to this one. It’s strange since they are part of a very reputable Hospital in a large suburb of a major city. You think they would hire the best.
Because I never was even with heavy periods my Hemoglobin was around 14 and 15. In 2022 it was 11.4 so it was right over normal according to the chart. And now it’s 9.2.
Dr respond. Kind of annoying. So no other tests? No recommendations for a Hematologist? No getting a glucose meter to keep track of my blood sugar?
“I added on the iron tests, and it does appear to be low - I would recommend over the counter iron supplements to take every other day.
The sugars are quite high so I would recommend checking again in 3 months. I have ordered this and the iron levels for that time. I'd recommend a follow up at that time to review too.”
When my hemoglobin dropped two grams over a 6 month period, my PCP ordered the iron studies, B12 and folate levels to determine the most probable cause of the anemia ( iron deficiency versus B12 or folate deficiencies). When the iron studies came back showing severe iron deficiency, she instructed me to take oral iron, which I did though even after a couple months of this there was not much if any improvement- indicating probable active bleeding somewhere. I'm post-menopausal so the most likely source of that bleeding was somewhere in the GI tract, so she ordered fecal occult blood tests (x3, to be done on different days) which in my case all turned out to be positive. She referred me for endoscopies, upper and lower to find the source. Turned out to be colon cancer.
Not saying this will be the same in your case, everyone is different. But if you're iron deficient, it's time to start looking at where that blood loss might be occurring. If you're premenopausal, heavy periods might be considered, but fecal occult blood testing might be a good idea to rule in/rule out bleeding from there as a possible cause.
Dr respond. Kind of annoying. So no other tests? No recommendations for a Hematologist? No getting a glucose meter to keep track of my blood sugar?
“I added on the iron tests, and it does appear to be low - I would recommend over the counter iron supplements to take every other day.
The sugars are quite high so I would recommend checking again in 3 months. I have ordered this and the iron levels for that time. I'd recommend a follow up at that time to review too.”
Find a doctor who knows what he's doing. This one doesn't.....Fe defic only occurs from blood loss. The cause MUST be found. You don't want to delay diagnostic testing for three months because the cause could be a gi or gyne cancer...Regardless of the cause, taking Fe will bring the rbc count back up. You don't want to avoid doing the diagnostic tests just because the pills "cured" the anemia.
If anemia is not causing compromise of the cardio-respiratory status, then there's never a need to replace Fe with injections or to use blood transfusions. Pills are good enough. They can upset the stomach in some pts-- take lower doses over longer time courses....The injections can cause an unpredictable anaphylactic reaction....pretty dumb to take that risk if you don't have to.
PS/ This is definitely iron loss anemia. The other causes of microcytic anemia are genetic so you'd have a lifetime history of this. The low ferritin level leaves little room for doubt....With a normal WBC count and differential and normal (slightly elevated, reactive) platelet count, there's nothing to suggest a bone marrow problem/need for a hematology consultation.
When I had horrible blood results, I was also in peri-menopause and turned out I had fast growing fibroids. Hemoglobin was 4.5 and the big fibroid had a blood supply as thick as the surgeon's finger, so he claimed. Iron supplements were horrible and after surgery in hospital they said stop taking them as it's too high now.
When I had horrible blood results, I was also in peri-menopause and turned out I had fast growing fibroids. Hemoglobin was 4.5 and the big fibroid had a blood supply as thick as the surgeon's finger, so he claimed. Iron supplements were horrible and after surgery in hospital they said stop taking them as it's too high now.
I think that is the working diagnosis of the PCP.
The MCV is a good measure of chronicity of bleeding in my view. A 66 is severe microcytosis. One event of multiple events won't get the MCV that low. Only chronic bleeds can get that low over time. Rest assured uterine bleeding can kill you on any given event.
A 4.5 hemoglobin is severe anemia that is critical and life threatening. I would look at the MCV to see how much time I have to get blood ready for transfusion. The lower the MCV the more time I had. A normal MCV is only slightly low then I would rush like hell. I hate to say it but gynecologists can panic with such massive transfusion protocols. Regular trauma surgeons deal with it regularly and we have a massive transfusion protocol (loss of more than ten units of blood-entire blood volume) where everything is regimented and choreographed. Gynecologist just aren't involved with it on a regular basis so they can panic in not knowing the process or what to give or order or who does what. Some of the most stressful cases involve gynecological emergencies of people running into the blood bank and give me everything you got now demands. They always made me nervous and on edge. I had a coworker that had a massive GI bleed where she was alert at the time and taken to surgery where they didn't know what blood products to order or how many and she told them to order a transfusion protocol of 4:4:1 blood plasma platelet products and initiate keep ahead 4 units. Tragically they had to take out her entire colon because they couldn't find the location and had to take it all out.
Infusion of blood is similar to an iron infusion as the iron in the transfused blood is recycled just like regular native blood.
Find a doctor who knows what he's doing. This one doesn't.....Fe defic only occurs from blood loss. The cause MUST be found. You don't want to delay diagnostic testing for three months because the cause could be a gi or gyne cancer...Regardless of the cause, taking Fe will bring the rbc count back up. You don't want to avoid doing the diagnostic tests just because the pills "cured" the anemia.
If anemia is not causing compromise of the cardio-respiratory status, then there's never a need to replace Fe with injections or to use blood transfusions. Pills are good enough. They can upset the stomach in some pts-- take lower doses over longer time courses....The injections can cause an unpredictable anaphylactic reaction....pretty dumb to take that risk if you don't have to.
PS/ This is definitely iron loss anemia. The other causes of microcytic anemia are genetic so you'd have a lifetime history of this. The low ferritin level leaves little room for doubt....With a normal WBC count and differential and normal (slightly elevated, reactive) platelet count, there's nothing to suggest a bone marrow problem/need for a hematology consultation.
Iron deficiency doesn’t only come from blood loss. I’ve been checked inside and out. I simply don’t absorb oral iron, especially now. I had WLS in 2011 but have had secondary RLS for about a decade before that. And my RLS is fixed when I have iron infusions.
Unfortunately the only person who can deal with iron infusions in most areas is a hematologist not a PCP. So yes, a hematology referral is likely. Most PCP’S prefer to hand that off.
Unfortunately the only person who can deal with iron infusions in most areas is a hematologist not a PCP. So yes, a hematology referral is likely. Most PCP’S prefer to hand that off.
How did you conclude that OP needs iron infusions? You've made several diagnoses in this thread that are confusing and represent bad advice. We don't know what the cause of this deficiency is, and it seems much more likely that a gastroenterology referral is needed. Yet you seem confident that this is a hematological issue and OP needs infusions. How did you arrive at that conclusion?
Iron deficiency doesn’t only come from blood loss. I’ve been checked inside and out. I simply don’t absorb oral iron, especially now. I had WLS in 2011 but have had secondary RLS for about a decade before that. And my RLS is fixed when I have iron infusions.
Unfortunately the only person who can deal with iron infusions in most areas is a hematologist not a PCP. So yes, a hematology referral is likely. Most PCP’S prefer to hand that off.
We often use the "horses vs zebras" analogy on this formum....Your case is not only a zebra, but a pretty rare species at that...and we won't mention that just because you tend to naturally run low Fe levels doesn't mean you're immune from getting bleeding ulcers, colon cancer etc etc....How often should we assume your falling Fe levels is just your same old poor absorption acting up?
We often use the "horses vs zebras" analogy on this formum....Your case is not only a zebra, but a pretty rare species at that...and we won't mention that just because you tend to naturally run low Fe levels doesn't mean you're immune from getting bleeding ulcers, colon cancer etc etc....How often should we assume your falling Fe levels is just your same old poor absorption acting up?
Not only am I a zebra, I’m a spotted zebra with stripes.
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