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Forum Name: Hematology Topics

Question: Severe Anemia not responding to iron infusions


 rar - Mon May 07, 2007 2:17 pm

Hi! I am 28 years old. I started iron infusions and my hemoglobin was at a 4.5. I received 13 (125 mg each infusion) total at that time and the highest my hemoglobin reached was 7. My doctor told me at that time that it if it was truly an iron definiciency condition that many infusions should take care of the problem. However after 2 weeks without any infusions I began to feel very fatigued again and had my hemoglobin checked at my family doctors office and it was 6.8 then four days later at my hematologist office it was 5.2. He tested my urine for hemoglobin and iron due to the fact that I have been a distance "runner" for many years however all of those tests have come back negative. He decided to have me take 10 more iron infusions. I am wondering if there are other conditions that might be masked by iron deficiency or some other things that we should be considering. My doctor seems to not know what to check for at this point? Thank you for any help that you can offer to me.
 Dr. Chan Lowe - Mon May 07, 2007 3:46 pm

User avatar There are several causes for anemia. If your anemia was due to iron I would think it would have responded to the iron infusions.

Do you have the rest of your CBC results (especially the MCV and RDW)? This would help limit the possibilities.

If you had hemoglobin in your urine (which would show up as blood) you may have an antibody that is attacking your red blood cells.

Follow up with the hematologist will be important.

Best wishes.
 rar - Tue May 08, 2007 7:12 am

This is a follow up to the question that I posted yesterday answered by Dr. Lowe. They did not find any hemoglobin in my urine. My RDW is high at 22.8% currently and my MCV is 76.6 and MCH is 23.0 and MPV is 6.2. I don't know if that would give any further suggestions as to what could be causing my anemia. If there are any further suggestions with this additional information I'd appreciate it. Thank you!
 Dr. Chan Lowe - Wed May 09, 2007 6:27 pm

User avatar Your RDW is quite high, suggesting a few possibilities. One is that your bone marrow is working hard to replenish your RBC's and sending out young red blood cells that typically are bigger.

Another possibility is that you have two different sized RBC's due to a hemaglobinopathy trait or other red cell condition.

A peripheral smear and a reticulocyte count may also help.

Your MCV is a little low suggesting the possibility of an iron deficiency anemia but there are other things that can do this as well.

Your hematologist should be able to guide you to the next needed test.

Best wishes.

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