Q. I am severely anemic. Kindly help.

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Patient's Query

Hello doctor,

I am a severely anemic patient. I have been on iron and B12 shots for three decades, but still, there is no improvement. I have got enlarged spleen, IBS, and also no absorption from the gut. I had undergone so many tests but nobody seems to have answers. I stay exhausted, dizzy and pale. Can anything help my severe anemia?

Doctor's Answer

Dr. Prakash H Muddegowda
MBBS., PGDGM., MD PATHOLOGY
Geriatrics, Hematology, Pathology

Hi,

Welcome to icliniq.com.

As you are on iron and vitamin B12 shots, I would assume that it could be nutritional. It is obvious that no absorption from the gut and also IBS will complicate it. Enlarged spleen could be due to increased destruction in spleen or production of cells in the spleen to improve anemia (extramedullary hematopoiesis).

I would like to know the following details:

What type of anemia have you been diagnosed?
Do you have any family history related to this?
Do you have any active bleeding?
What is your age?
What are the various treatments being taken or received in the past, including blood transfusion?
Have you done any tests or evaluation?
Do attach your present hemoglobin levels and complete blood report. Also, iron and vitamin B12 levels are necessary.
Do you have any associated chronic diseases?

Patient's Query

Thank you doctor, here are the answers to your questions.

I am a 54 year old person with no related family history. My hemoglobin level is 9.9g/dl. Blood tests and bone marrow biopsy results are normal with normal bleeding time. I had Chinese acupuncture done, which has relieved the chronic pain and bowel problems. I never underwent any transfusions. I am having pain on my left side, right under the ribs that caused shoulder pain. So, I have asked for an endoscopy and colonoscopy as well. I am so tired of being weak and dizzy and I do have inflammatory problems. I eat a diet high in green foods and whole food vitamins. But no matter what I eat, I still stay overweight.

Doctor's Answer

Dr. Prakash H Muddegowda
MBBS., PGDGM., MD PATHOLOGY
Geriatrics, Hematology, Pathology

Hello,

Welcome back to icliniq.com.

The above results indicate that you probably never had severe anemia. Your hemoglobin level shows only mild anemia and it will not be the main cause of weakness or dizziness. Additional causes for weakness, normally are hypothyroidism and dehydration.

Blood is normocytic and normochromic. Your bone marrow is responding well, which can be confirmed by reticulocyte count test in blood. If done, reticulocyte count should be around 2-3%. Not sure about the blood loss in menstrual cycles, which may be contributory.

Due to IBS (Irritable Bowel Syndrome), nutritional absorption is impaired and essential supplements are necessary. Your diet is good, continue the same. Divide your meals into 5-6 times per day. Take at least 6-8 liters of water per day. Mild exercises are necessary and maintain a standard sleep schedule.

Hope you have been evaluated for hypothyroidism. If not, thyroid hormone studies will be necessary. Endoscopy and colonoscopy are necessary for evaluation of any disorders. If any abnormalities are found, it may help in the identification of the possible cause of weakness.

I hope it will be of great help to you.

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