Please give some advise to improve my hemoglobin level.

Question

Hi doctor,

Recently, I had RARP surgery for prostate cancer. My Hb level post-surgery fell to 10.8 and I was advised to stay on the iron supplement Dexorange syrup one teaspoon thrice daily after meals. In view of ongoing treatment for erosive gastritis, which is now under control, the Iron supplement was started three months ago. Then, my Hb level improved to 12.5. I had a CBC, folic acid, and iron study and I have enclosed the reports for your reference. I am a vegetarian. Please advise further course of action as I have been advised to stop the Dexorange syrup after three weeks and continue with an iron-rich diet. My gastroenterologist is not in favor of long-term usage of Iron supplements. The stomach ulcers due to H.pylori have been treated and the stomach lining restored. Currently, I am taking Nexpro 40 mg on an empty stomach and Librax once at night. My CBC report issued an alert for anisocytosis. My amylase level is around 174 U/L, but pancreatitis and bile duct obstruction has been ruled out. I am taking Unienzyme tablets in the morning and night along with one probiotic capsule Vizylac. Please advise if any attention or investigation or treatment is required further.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

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

The hemoglobin level is improving. However, it has not improved to the levels that we will be satisfied to stop supplements.
I am also not in favor of continuing supplements when the same nutrition can be obtained through diet. However, if iron-rich diet, particularly a vegetarian diet is sometimes inadequate. During this time, I would strongly advise supplements.
At present, as you are ready to take care of your diet, I would advise you to continue the supplements for another four weeks and then continue with the same iron, vitamin B12, and folic acid-rich diet.
Hemoglobin is good for now. Repeat the test after three months and if it is well above 13 to 14 g%, then continue with the same diet. If it has fallen below 12 g%, then you will need supplements.
Based on normal MCV (mean corpuscular volume) and increased RDW (red cell distribution width), I suspect you are having dimorphic anemia. So, as I specified earlier all three, iron, vitamin B12, and folic acid should be there in the diet.
As all the values are near normal, no further tests are necessary. Only, a hemoglobin test after three months should be adequate. If it is normal, then you can continue the same.
As no specific cause has been found for serum amylase, do not be worried about it at present. It can also be an increase in stress, which you have been under for the past few months. Let us concentrate only on hemoglobin improvement and a nutrition rich diet.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, continue Zincovit with Dexorange syrup until hemoglobin improves beyond 13 to 14 g%.
If the hemoglobin level is good, then the hemoglobin estimation alone is adequate. A complete blood count test is not necessary.
If the hemoglobin level has fallen below 12 g%, then CBC is necessary to check.