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

Question

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 x10^3/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?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Can you forward your hemoglobin electrophoresis report to me?

Please answer this question.

Thank you.

Answer 2

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.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 3

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.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.