Kindly suggest remedies to raise RBC count in anemic.

Question

Hello doctor,

My mother is suffering from anemia. She was hospitalized with a hemoglobin of 4.6. After two units of blood transfusion, it came up to 6.8 and went back to 6.3 after 10 days, then another unit was transfused. Endoscopy, colonoscopy, and CT-scan have been done, but no concrete reason was found. Then serum iron and ferritin test showed ferrozine, cobas/6000 at 396 micro-gm/dl, and ELFA, mini vidas 10.6 ng/ml. She is currently taking Astier XT one tablet per day.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Her RBC count is very low with low serum ferritin and high serum iron (attachment removed to protect patient identity). Also, her anemia is normocytic normochromic, which is generally seen in bleeding due to chronic blood loss or in chronic disease. Other causes can be chronic kidney disease or liver disease, both of which are unlikely since the renal and liver function tests are standard. Since occult blood is present in stool, a gastrointestinal bleed is the most likely cause. But that has been ruled out by endoscopic tests.

However, occult blood in the stool may be falsely positive in the following instances if it is a chemical occult blood test, like iron medication (which is the most likely cause in your mother's case), certain fruits and vegetables, vitamin C, and meat. It is better to have the stool tested for occult blood using an immunologic test, as it is not affected by these factors.

A bone marrow biopsy can be done to rule out aplastic anemia. Other causes of anemia associated with chronic disease should be ruled out, such as autoimmune diseases. Blood transfusions will not cure the anemia unless the underlying cause is treated.

I hope this helps.

Answer 2

Hi,

Welcome back to icliniq.com.

I have gone through the attached blood test results. Based on those I have ruled out liver and kidney disease as a cause of your mother's anemia. The specific test for occult blood is not specified in the result.

I hope this helps.

Answer 3

Hi,

Welcome back to icliniq.com.

I have assumed that the chemical method was used, as it is easier and more widely used. I want to request that you repeat the stool test for occult blood, using the immunologic method. If it comes back positive, then there is a gastrointestinal bleed that has not been detected. If it is negative, then the cause of her anemia is some other chronic disease that needs to be worked up.

I hope this helps.

Answer 4

Hi,

Welcome back to icliniq.com.

I would suggest you get a peripheral blood smear study and thyroid function tests done. That is if the occult blood in the stool is negative by the immunologic test.

I hope this helps.

Answer 5

Hi,

Welcome back to icliniq.com.

You are welcome. Take care.