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Q. My hemoglobin count is low. Could it be due to my heavy menstrual flow?

Answered by
Dr. Prasad Eswaran
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 07, 2017 and last reviewed on: Nov 19, 2021

Hello doctor,

I have been suffering from anemia for over 12 years now. I am very sure that within this time frame, my hemoglobin level has never been higher than 10 g/dL. Recently, my hemoglobin was at 7.1 g/dL. I have seen many doctors and have informed them of a family history of a kidney disease, even though my RFT are always within range. All the doctors claim that the reason for my chronic anemia is due to my menstrual period. I do have a heavy menstrual cycle lasting anywhere between five to seven days, but in all honesty, it has never been a cause for concern. I have begun seeing a new hematologist since last year, and according to my lab results, it seems that I have a condition called alpha thalassemia in association with microcytosis. I also learned that I have abnormally shaped RBCs, called as poikilocytosis and the list definitely goes on.

I do not want to self-diagnose, but my theory is that there is an underlying issue. When I mention that to the doctors they do not want to think on those lines and try to convince me that it is due to my menstruation. I have a normal month and a heavier month, but it has never been a cause for concern. In looking at my recent blood work, which is not too different from my previous lab results throughout the years, I noticed that my reticulocytes percent is 1.3 %, but my absolute is within the range. I have 2 % saturation, ferritin is at 2 %, iron binding is high at 489 mcg/dL. BUN, and creatinine are fine. Platelets are abnormally high at 716 Thousand/uL. WBCs are all normal. So, my question is, should I worry about my bone marrow, my kidneys or could this truly just be my menstrual cycle?

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#

Hello,

Welcome to icliniq.com.

  • Can you forward your hemoglobin electrophoresis report to me?

For more information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

Hello doctor,

Thank you for responding. As you can see, I have attached my most recent blood work as well as the one that was done last year. I am sorry that I have attached so many sheets. I hope this helps.

#

Hello,

Welcome back to icliniq.com.

  • Your hemoglobin electrophoresis is fine. I have few differential possibilities.
  • One is a simple iron deficiency anemia, which needs intravenous or intramuscular iron supplements, followed by oral iron tablets to keep your iron reserves full.
  • The second possibility could be red cell aplasia which needs further evaluation if iron therapy is not helping.
  • You may need to undergo bone marrow aspiration and biopsy for evaluation.
  • Let us first correct your iron deficiency and then reassess you in a month's time. Till you get your doctor's appointment, start on oral iron tablets.

For further queries consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist

Thank you doctor,

I will definitely mention this at my next appointment. I am currently having IV infusions of Venofer and it seems to be helping for now.

#

Hello,

Welcome back to icliniq.com.

  • Your hemoglobin levels should improve in three to four weeks.
  • For immediate improvement of symptoms, a blood transfusion can be considered.

For more information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist


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