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Q. Why do I have a bleeding problem and a low hemoglobin level?

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Chithranjali Ravichandran
This is a premium question & answer published on Aug 18, 2021

Hello doctor,

I am a 24-year-old female. I have a 8-month-old baby. I am suffering from a thickened uterine lining (18 mm) and experiencing heavy bleeding for the last three months. After using hormonal pills (Ovipauz) for one month, the lining returned to a normal thickness of 6 mm, but I still have heavy bleeding. Meanwhile, my husband got Corona positive. I was tested negative but had all the symptoms. I tried keeping drops of lemon in my nose to relieve the blockage and ended up bleeding from the throat the following day. I visited three E.N.T doctor, and all tests were normal. Doctor advised me to do CBC and two other tests, in which my MHC and MCV are low. Is it normal or anything to concern? I had low hemoglobin during my pregnancy and took iron injections; after delivery, I am having this bleeding problem. I want to know whether my MCV and MHC are normal. Some are saying it to be thalassemia minor.

I am really worried.

Please help.

#

Hello,

Welcome to icliniq.com.

Following is my opinion for your questions;

In pregnancy, hemoglobin level usually goes down, so do not worry about that.

In the attached reports (attachments removed to protect the patient’s identity), your hemoglobin level is low, along with low PCV (packed cell volume) and low blood indices.

So, it is suggestive of microcytic hypochromic anemia.

There are many causes for microcytic hypochromic anemia like iron deficiency, thalassemia minor, blood loss, chronic disease, etc.

I suggest investigating further with serum iron, ferritin, and other iron parameters investigation as well.

Since you have bleeding history twice, it is advisable to investigate with coagulation parameters like a PTT (partial thromboplastin time) and coagulation factor estimation for further workup.

You can visit a hematologist for a detailed discussion and physical examination accordingly.

Regards.

Hello doctor,

Thanks for the reply.

My bleeding was due to endometrial hyperplasia. Now it returned to the normal level. Could you please tell me the symptoms of thalassemia minor? When does a person get this condition? I am experiencing this discomfort only after my pregnancy.

Kindly help.

#

Hi,

Welcome back to icliniq.com.

Following is my further opinion on your question.

Yes, bleeding could be due to endometrial hyperplasia as well. But if the bleeding continued, then a coagulation profile test should be done. You can take a Tranexamic acid tablet if endometrial bleeding continues.

In thalassemia minor, the patient complains of chronic fatigue, dizziness, and severe fall in hemoglobin level like below 7 g/dL, difficulty in breathing can also occur.

However, symptoms of iron deficiency anemia and thalassemia minor are the same as mentioned above.

In thalassemia minor, bleeding is not the main complaint; instead, fatigue is the main complaint.

To rule out thalassemia minor, HPLC (high-pressure liquid chromatography) test should be done.

Let me know if I can assist you further.

Best regards.


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