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Forum Name: Hematology Topics

Question: Should I see a hematologist about my anemia?


 rer1001 - Fri Dec 15, 2006 12:10 am

I am a 69-yr old male in generally excellent health. In Aug'06 during a routine blood test I was diagnosed as having a mild case of iron deficiency anemia (IDA). My hemoglobin level was 12.0 g/dL, and I was told that anything below 13.0 g/dL classified me as having IDA. My other blood test results (with units omitted) were: ferritin (6); iron (17); TIBC (405.6); transferrin (290); WBC (7.0); RBC (4.78); HCT (36.8); MCV (76.9); MCH (25.2); MCHC (32.7); RDW (18.3); PLT (234); MPV (7.9).

I have had no symptoms of IDA. I do not take any medications, vitamin supplements, aspirin, or NSAIDs. There is no family history of IDA, and I have had only minor surgeries (bunionectomy and arthroscopic surgery of one knee).

When I was diagnosed with IDA, my primary physician said that blood loss in the GI tract was the first thing that needed to be ruled out. Since then I have had the following tests which have so far not indicated any blood loss: fecal occult blood test; colonoscopy; upper endoscopy; CT scan of the abdomen; and capsule endoscopy. The gastroenterologist now recommends an enteroscopy to examine and take a biopsy of an isolated area in the upper third of the small bowel which revealed some mild irritation and loss of villi.

My questions:
1. If after all these GI tests are completed, no blood loss has been discovered, what other tests can help determine the cause of the IDA?

2. My treatment thus far has been strictly by the gastroenterologist. Should I see a hematologist for another opinion?

Thanks in advance for your assistance. rer1001.
 Dr. Tamer Fouad - Fri Dec 15, 2006 6:56 am

User avatar Hello,

I agree with Dr. Safaa's comprehensive response to your previous post. I understand your reasons for concern.

I am not a gastroenterologist so we will have to wait and see your gastroenterologists decide concerning the jujenal lesion. If according to their assessment it looks significant then it should be biopsied. That it is the cause of your IDA is possible even though this is not supported by your occult blood in stools test (which was negative).

Your gastroenterologists want to be absolutely sure you don't have don't have any nasty (such as a tumor) that's causing your IDA, given your age.

Once that is ruled out, other more benign causes of IDA can be safely be explored. At this stage it would be a good idea to check with a hematologist. Other causes include malabsorption of iron and decreased intake.

Sometimes all that is needed is iron supplements to correct the condition. However, you are right not to take them now so they do not interfere with your investigations.

All the best and do keep us updated!
 rer1001 - Fri Dec 15, 2006 1:43 pm

Thank you for your response. I think I misunderstood Dr. Safaa's reply to my initial post. I have made another post on the Gastroenterology forum, and I will discontinue this one.

Thanks again for your information and assistance. rer1001.

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