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Forum Name: Hematology Topics

Question: Low Ferritin and Low Hemoglobin = colonoscopy?


 owlsmg - Mon Mar 26, 2007 9:51 am

Hello, I am a 34 year old female who has recently received a blood test back from my Dr. with a Ferritin level of 2 (normal for this lab 10-291) and Hemoglobin of 10.9 (11.5-15). My Dr. is recommending a colonoscopy, because he is concerned that the low levels are due to bleeding.

Background: Have always had low iron, father has low iron, I am a fish-eating vegetarian w/in normal weight range who takes a mutli-vitamin everyday and exercises 4-5 times a week. I am not fatigued, as typical with low iron, but rather would be considered high energy.

Questions:
1) Is the colonoscopy really necessary? For reasons both financial and of time concerns, I would really rather avoid this test unless absolutely necessary.
2) Couldn't the low ferritin levels be due to something blocking absorption of the iron I get? I eat a very high-fiber diet, and am on Prilosec for GERD, both of which I have read can inhibit iron absorption.
 Dr. Chan Lowe - Mon Mar 26, 2007 5:45 pm

User avatar There are several possible causes for your condition. The low ferritin makes low iron very likely. Low iron, in turn, leads to low hemoglobin.

It is possible that you are low on iron from chronic blood loss but there are other possible reasons as well. You may simply not be getting enough iron through the GI tract. Absorption of iron can be a little finicky. Iron absorption can be increased by taking it with vitamin C or citric acid.

If there is concern about blood loss through the GI tract, a test for hemoglobin in the stool (called a hemacult test) can be done to detect blood in the stool. Typically this is repeated on three separate stools to help increase sensitivity. If it is positive I would definitely recommend a colonoscopy.

Often, the source of blood loss in women is the menstrual period.

Of note, there are other indicators of iron deficiency anemia such as a low MCV and an elevated RDW. Other deficiencies, such as folate or vitamin B12 can cause low hemoglobin, but would typically cause a high MCV.

You may consider having a bit more work up before having the colonoscopy. Keep in mind that my recommendations are solely based on what I have been told. I do not have your full medical chart and have not examined you. In general, I always defer to the recommendations of your regular doctor but you may be able to discuss some of these things to get more information.

Best wishes.
 owlsmg - Tue Mar 27, 2007 10:20 am

Thank you for quick reply. Your response makes me feel much better. I have a consultation appointment next week with the GI specialist to whom my GP referred me, and I will bring up some of these other considerations with him. My full test results will be transferred to him from my GP, so he will have the full picture so we can discuss some options.

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