What are the causes of my iron-deficiency anemia?

Question

Hello doctor,

I am a 50-year-old male who, until recently, was in relatively good health, other than idiopathic severe osteoporosis and depression. Over the past six months, I have become lethargic, out of breath after very simple tasks, and have experienced a loss of memory. My primary doctor noticed that my hemoglobin had been dropping over the past year.

After more testing, I was diagnosed with iron-deficiency anemia. I underwent eight weekly infusions, which finally got my hemoglobin close to the normal range. However, while my iron is low, my unsaturated iron binding capacity is high at 421, my total TIBC is high at 471, and my transferrin saturation is low at 11. Prior to starting the infusions, my platelets had been high and climbing.

After the eight infusions, my platelets were only normal for a week. They have begun rising again and are a little high at 502. My RDW has always been out of range and is now high at 17.9.

Also, a month ago, my CRP was 1.29; it is now 2.2. I have had an ANA screening for autoimmune, and it came back negative. My stool has been tested twice, and it has no blood. My homocysteine and PSA are normal. I am still lethargic and getting worse, and I am constantly short of breath.

My short-term memory is not good. I now have constant pain in my lower back in the kidney area, but all tests for kidney function have been normal. My current hematologist has ordered a CT scan of my abdomen with barium contrast, but my insurance has not approved it yet.

I understand that anemia is a symptom of something else, so what is the CT with contrast going to look for? Should I be concerned about the pain in the lower right side of my back? If you were in my shoes, would you see your doctor again or wait a couple of weeks until the CT is complete?

What does your gut tell you is the most likely cause based on the limited information listed above? I have attached all my test reports.

Please advise.

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

Based on your query and attached reports (attachment removed to protect patient identity), my opinion is as follows:

CT with contrast helps us look for any structural abnormalities. If there are any strictures (narrowed areas) or any masses (like carcinoma), then based on the findings, the cause of anemia can be found. Back pain, especially with osteoporosis, is something to be serious about. You need to strengthen your back muscles and backbone with exercises, and you also need calcium supplements.

A hemoglobin level of around 11 to 12 g/dL is good. There is no emergency at present. You need to watch for any bleeding in stools or any tarry or dark-colored stools. Also, improved nutritional intake, such as protein-rich and vitamin-rich supplements, is essential. I do not foresee any serious issues in the next couple of weeks.

Malnutrition could be the possible cause. However, the platelet count is a bit high, which could be due to minor bleeding. I hope you have taken deworming medication like Albendazole. High RDW (red blood cell distribution) is usually secondary to a nutritional cause. You need to maintain an active and nutritional life.

I hope it helps. Any further queries are welcome.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Based on your query, my opinion is as follows:

Iron-deficiency anemia need not always be due to poor intake. It could be due to poor absorption of iron, too. That could be the reason for iron infusion rather than iron oral supplements.

Causes of poor absorption could be mucosal atrophy of the duodenum, poor gastric acidity, etc. Get a reticulocyte count done. If it is improving, then do not worry. If not, then bone marrow functioning will require evaluation. As you said, it is not the diet, so what is going on is not getting absorbed. That could be the problem.

I hope it helps.

Thank you.