How to find out the reason for shortness of breath and extreme fatigue?

Question

Hi doctor,

My mom, who is 76 years old, has a transferrin saturation level of 17. She has been scheduled for iron infusion therapy. She feels extremely tired, short of breath, and has arthritic pain. She cannot tolerate oral iron. She has had iron infusions before but does not last long. What to do? This problem has been there for a long time. She has had a cardiac work-up, which was good. Currently, she is on blood pressure medication and pain medicine for arthritis.

Answer 1

Hello,

Welcome to icliniq.com.

I am trying to understand whether she has iron deficiency anemia or anemia of chronic disease, or myelodysplastic syndrome.

Did she ever get a bone marrow biopsy or hemoglobin electrophoresis? Can you share her latest complete blood count (CBC) before and after the infusion? Also, how frequently does she require the infusions?

Can she tolerate foods containing iron? Have you tried giving her iron-rich liquid and flavored supplements rather than pills? What is the side effect of oral iron?

Did you ever figure out where she is losing all this iron? Either colon or urine? Did she have a colonoscopy or FIT (fecal immunochemical test) for colon cancer screening? What about a pap smear (Papanicolaou test)? Did she have a urinalysis for blood?

Please allow me to serve you better by answering these questions and sharing CBC and CMP (comprehensive metabolic panel), including kidney and liver function test results.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for sharing the pertinent history (attachments removed to protect the patient's identity).

It seems like she is maintaining reasonable hemoglobin as of now, and the ferritin is also in a good range. I would highly recommend investigating the cause of iron deficiency anemia. Given her age, the most important thing we worry about is colon cancer or blood loss through the genitourinary tract. I am still curious about the cause of anemia. Did you ever figure out why she is not absorbing iron? Is there any family history of celiac disease or colon cancer? When was her last upper GI (gastrointestinal) endoscopy and colonoscopy? Is there any vaginal bleeding or dark black stools? Also, is her vitamin B12 and vitamin D normal? Does she take Aspirin or other blood thinners?

Answer 3

Hello,

Welcome back to icliniq.com.

Thank you for the information.

I would highly recommend that her vitamin D should be checked with the next blood draw, and she should be seen by a gastroenterologist. She would definitely benefit from an EGD (esophagogastroduodenoscopy or upper GI endoscopy) and colonoscopy.

For her persistent SOB (shortness of breath) and fatigue, ensure that her cardiac and lung function is checked. I would suggest starting with an EKG (electrocardiography) and getting an echo of the heart.

Anemia can cause fatigue and tiredness, but not at the hemoglobin of 11.7 and ferritin of 123.

She will also benefit from a CT (computed tomography) chest and lung function test if she has a history of smoking in the past.

Does she have a PCP (primary care physician)? All these investigations can very quickly be ordered by her PCP.

There are oral supplements, which are very gentle to the stomach, like Feosol iron supplements and Geritol; try using them every day.