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Q. Does Entocort intake cause severe anemia?

Answered by
Dr. Srinivas Morampudi
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 31, 2019

Hello doctor,

I am a 62-year-old female. I was diagnosed with collagenous colitis following colonoscopy biopsies. I started on Entocort, three days later I have severe swelling in feet and ankles. I am fatigued the next day. On the seventh day, I had swelling of lips and a strange feeling in the throat. I called the doctor and he stopped the medication.

My blood report shows:

Hemoglobin - 3.6 g/dL,

RBC - 1.38 million/mm3,

Iron - 11,

Saturation - 3.

Fecal stool sample postive.

I went to the ER, I was given two units of blood. My hemoglobin raised to 7.5 the next day. I was discharged. Endoscopy was performed and my biopsy report is negative. I had minor stomach inflammation. My next bloodwork shows

Hemoglobin - 8.1 g/dL,

RBC - 3.05 million/mm3,

Iron - 51,

Saturation 12.

Vitamin B12 - 648.

Immunoglobulins A and G are pretty low. Gastroenterologist says need to do small cap endoscopy to see if there is bleeding in the small intestine. My new stool sample results are not back yet, but stools have not been dark. What other tests need to be done to determine the cause of anemia? List the possible that medication caused anemia since I had such a severe reaction.

Current medications:

No prescription, only supplements. Vitamin D3, CoQ 10, Methyl B12, and Curcumin.

Dr. Srinivas Morampudi

Internal Medicine


Welcome to

Entocort (Budesonide) is a corticosteroid. It is very unlikely to cause anemia, especially to the extent that you had.

What was your hemoglobin prior to the colonoscopy? If it was near normal and then dropped to 3.6, that would be a huge drop. If you had gastrointestinal bleeding leading to such a huge drop in hemoglobin in a short span of time, I would expect that you would have noticed the blood in your stool. Minor bleeding over longer periods can lead to anemia, and in those cases, serum ferritin (a storage form of iron) would be low. Acute blood loss anemia usually does not cause serum ferritin to drop.

Did you have a serum ferritin level done along with your other iron studies? If the serum ferritin is less than 15, it is almost definitely iron deficiency. Iron deficiency is either due to dietary reasons or blood loss. Dietary iron deficiency is rare in developed countries. So, blood loss has to be ruled out. If no obvious reason is identified on upper GI endoscopy or colonoscopy, then small bowel pathology has to be ruled out by capsule endoscopy. Other reasons for a rapid drop in hemoglobin would be hemolysis (where the red blood cells are destroyed for various reasons). This would be diagnosed by tests like:

1. Peripheral blood smear

2. Serum haptoglobin

3. Direct and indirect bilirubin

4. Direct Coomb's test

5. LDH (lactic acid dehydrogenase).

Please attach any reports you have with you. That may help me give you a better answer.

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