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Q. Kindly suggest remedies to raise RBC count in anemic.

Answered by
Dr. Smrita Singh
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 03, 2019

Hello doctor,

My mother is suffering from anemia. She was hospitalized with hemoglobin 4.6. After two units of blood transfusion, it came up to 6.8 and gone back to 6.3 after 10 days, then another unit was transfused. Endoscopy, colonoscopy, 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.



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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 unlike since the renal and liver function tests are normal. 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), certain fruits and vegetables, Vitamin C, meat. It is better to get the stool tested for occult blood by the immunologic test as it is not affected by these things. A bone marrow biopsy can be done to rule out aplastic anemia. Other causes of anemia of chronic disease should be ruled out like an autoimmune disease. Blood transfusions will not cure the anemia unless the underlying cause is treated.

Thank you doctor,

I have attached the complete history of CBC. I have also attached the reports of endoscopy, colonoscopy, CT scan, and other biochemical test reports.



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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.

Hi doctor,

Thank you for your detailed response.



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I have assumed that the chemical method was used since it is easy and more widely used. So I would ask that you please repeat the stool for occult blood and ask for the test to be done by the immunologic method. If it comes positive then there is a gastrointestinal bleed which has not been detected. If it is negative, then the cause of her anemia is some other chronic disease which needs to be worked up.

Thank you doctor,

So, apart from occult blood by the immunologic test, what other tests should be performed?



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

Hi doctor,

Thank you for your replies.



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You are welcome. Take care.

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