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Forum Name: Hematology Topics

Question: Please help, I don't know where to turn with Iron Problems


 keewester - Wed Mar 02, 2005 4:40 pm

Repost in hopes a Physician can help.....


Hi there,

I am a 41yo white female in central Florida with relativly low stress, married 18 years, 2 adopted children. 7 brothers and sisters all healthy. I was always a normal weight until I got married in 1986. I battled back and forth with diets, excercise, etc for 15 years. The highest I've weighed was 226 and that was just 10 months ago. As I sit here typing this, I am now 135. I did not try to lose weight. It's just gone.


In June of 2004 I started losing weight, just a few pounds here and there but hadn't altered my eating. I was getting more excercise at work - walking A LOT. So I figured that was the reason. Then I spent much of July vomiting on a daily basis. I would not get nauseated, it would just happen out of the blue with little warning. One day when I got sick, I lost a good 8oz of yellow fluid and thought "Ok NOW we go to the doc" My GP sent my blood out for testing and a few days later informed me that I have H Pylori Disease (HPy count was 1660) and that is causing my weight loss (then 40 pounds or so) and vomiting. They put me on a round of triple antibiotics and I went back 10 days later. I was still vomiting and down another 11 pounds. They then sent me to a Gastro Doctor.

He took some blood, did an exam and set me up for an Endoscopy. That turned out fine, he found no problems. He said he was concerned with my blood counts and took more blood. The day after I was to go for a upper and lower bowel series and the following week, a colonoscopy. The next day I could not hold down the barium and started vomiting quite a bit. There was a quarter size dollop of blood in the vomit and my husband called the doctor. They advised us to go to the ER immediatly, the blood work just got back and it was not good. That was August 19th 2004 (in between Hurricanes no less)

I was in the hospital for 9 days. I had every test imaginable, colonoscopy, MRI's and/or Catscans of my brain chest and stomach, doppler radar (or something like that...) on my legs, Sonograms & a Bone Marro Biopsy (what a joy that was, I'd rather have 3 colonoscopies) I bet I also gave them 10 pints of blood while I was there.

I never saw the same attending twice. It was so confusing, my Gastro Doctor came in twice but I barely remember it. He pretty much cleared me of any Intestional problems. The doctor that released me had a good 10 min talk with myself, my husband and my father in law before I left. Not one of us understood a thing he said. The nurse in the room also didn't understand. I followed up with one of the Hemotologists that saw me while there.

I know that my SED rate was as high as 93. My Hemoglobin was as low as 7 and my iron was at 6. I don't remember my Hematacrit.... I do have the documentation though. All tests except bloodwork came back normal or near normal. One of my stomach scans did show an enlarged spleen.

They ruled out any cancers. They told me I had severe iron and B12 deficiency and had to have Iron Infusions & B12 shots starting immediatly until my iron levels increased. They discussed the possibility of a Blood Transfusion but I've never had one.

Last week I had my 7th Iron Infusion and 10th B12 shot. My iron is at 12 as I type this. I am constantly weak. I get dizzy if I bend over to do something and stand up again. I'm pale with dark circles under my eyes and I'm just tired of all this. My hemotologist suggested I may have Celiac Sprue, I've looked that up and have NONE of the symptoms except Anemia.

I don't know how much more of this I can take. I know there was no iron in my marrow at all. I know my body won't absorb it. I eat foods rich in iron, I take iron & b12 supplements as well as my monthly infusions.

I continue to lose weight at about 10 pounds a month. I have little or no appetite and I have zero strength & energy. My family is worried, my employers and employees are worried and quite frankly, so am I. There has got to be something someone missed.

I don't know where else to turn. Can someone please shed some light on this mystery. I would be so very grateful.

Thank you for your time.

Ironless in Orlando
 Dr. Yasser Mokhtar - Wed Mar 16, 2005 9:58 pm

User avatar Dear ironless in Orlando,

Glucophage can cause nausea, vomiting and loss of appetite. It can also cause decrease in the vitamin b12 levels (but rarely causes anemia).

With glucophage, obese patients (who usually have insulin resistance with susbsequent high insuling levels and glucose intolerance) start to have improvement in their glucose intolerance and hence the insulin levels may actually go down and the patient will lose weight, but i think that what you are having is not secondary to glucophage as i think it can not cause that much weight loss on its own, there should be other helping factors such as exercise and a good healthy diet. However, since you already lost a lot of weight and may be some of the symptoms that you are having might be due to side effects of glucophage, i suggest that you stop it. i know you have been taking it for pcos, so unless you are still trying to conceive, i don't see why it can not be stopped.

Besides cancer, rapid weight loss without trying to can be caused by new onset diabetes, over active thyroid gland and others such as hiv infection and if you were living in a country where worm infestations are common, i would have said worm infestation (if you have travelled to such a country before all this started, i suggest a stool analysis). i am sure that you had all these tested for while being in the hospital. i am also sure that all types of cancers where looked for either by scans or blood tests. Cancers that are not looked for as aggressive as others are usually breast and those of the female genital tract such as ovarian and cancer of the cervix. One cancer that is not easy to detect is melanoma. But, if cancer was the cause behind your weight loss, i think that it should be an advanced cancer and there would have been no difficulty in finding this cancer whatsoever because it would be so obvious (even a melanoma).

At this point, i am not sure what is causing this weight loss. i suggest that you repeat the investigations once more (or at least some of the blood tests) to make sure that you did not have something that was missed.

Regarding the b12 deficiency, this is usually caused by an autoimmune condition called pernicious anemia where an essential component needed for absorption of vitamin b12 is not secreted by the stomach anymore due to the destruction of the stomach cells secreting this substance (by auto antibodies). For treatment, either vitamin b12 is given intramuscular or intravenous monthly or both the missing substance and vitamin b12 are given orally, in the both cases the stores of the vitamin (the weekly shots) have to be refilled first.

Regarding iron deficiency anemia, the most common cause is usually chronic bleeding which is either from the upper or the lower gastrointestinal tract (added to them in females, bleeding from the female genital tract) and you had normal both upper and lower endoscopies. If the cause was from somewhere inbetween upper and the lower gastrointestinal tract, usually a bleeding scan is performed at the time bleeding is suspected. Regarding female genital tract bleeding, heavy menstruations included, is a thing that is assessed by history. In addition to iron loss, there is inadequate supply that can cause iron deficiency. This can be caused by either not getting enough iron in diet or not being able to absorb iron (rare).

Having a bone marrow biopsy means that everything was done. i am sure that they did it but was hemolysis (destruction of red blood cells) excluded? Were your liver functions normal? Was erythropoeitin (a hormone produced by the kidneys that contorls blood production) level checked?

It does not take a long time to see the effect of therapy on blood production but the full correction usually takes a few months, so all the symptoms of fatigue and being pale and the other that are caused by the anemia are going to improve slowly.

i am not sure whether or not i have addressed all of your concerns, please, if i have missed something, point to it and i will try to cover it.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 keewester - Thu Mar 17, 2005 10:51 am

Thank you so much for your detailed response. I'm actually going to my GP today for an MRI followup and I will ask him about the blood work you spoke about. My infusion and monthly Hemotologist appointment is next week and I will follow up with him as well.

Good news is I have put on 6 pounds this week. Kinda scarey but good at the same time. I'm also feeling a bit more energetic and not so much fatigue. Perhaps there will be a light at the end of the tunnel for me now.

Thank you very much :D

Keewester
 Dr. Yasser Mokhtar - Thu Mar 17, 2005 11:34 am

User avatar Dear ironless in Orlando,

Please, keep us posted on how your appointments turn out.

Thank you very much for using our website http://doctorslounge.com

Yasser Mokhtar, M.D.
 keewester - Fri Mar 18, 2005 6:01 pm

Dr. Mokhtar,

I followed up with my GP yesterday - he is a fantastic guy with the best bedside manner. I took a print out of these posts in and had him look them over. My records indicated that my kidneys and liver are functioning fine. He ran some blood tests for Celiac Sprue and something else... they'll call when the results are in. Additionally he's sending me to a Neurologist and wants to rule out MS. I'm also following up with the Gastro Doc. It's surprising because I have been healthy my entire life, not a single problem outside your normal colds, flus, etc. Then I hit 40 and it all went downhill.

I'll keep you posted. He may also show up here as he expressed interest in the forum. Super nice helpful guy - no complaints with him at all. He loved my 'Ironless in Orlando" signoff :o

take care and thank you! :wink:
 Dr. Yasser Mokhtar - Sat Mar 19, 2005 12:54 pm

User avatar Dear Ironless in Orlando,

i am happy to hear that you are pleased with your doctor.

He is welcome any time on the website and if he would like to help by volunteering his time and effort, this will be most appreciated by patients like yourself who sometimes find some answers and comfort on our website.

Thank you very much for using our website http://doctorslounge.com

Yasser Mokhtar, M.D.

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