Is my low hemoglobin & fatigue linked to ulcerative colitis?

Question

Hi, Doctor,

I am a 38-year-old male. I have been living with ulcerative colitis for four years, and typically it is under control. I have been experiencing extreme fatigue for the past two weeks, more than my bowel problems. I go to the bathroom about four to five times a day, but I am so tired I can barely make it up the stairs.

I had blood work done recently, and my hemoglobin was 9.7 g/dL; that seems low. My CRP level is 16. I am currently taking Azathioprine at a dosage of 100 mg daily and Mesalamine at 2 g daily.

Could anemia be caused by slow internal bleeding, even if I am not noticing much blood?
Should I be taking iron tablets or getting an iron infusion?
How do I know if my condition is mildly flaring or if something more serious is going on inside?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concerns.

Your symptoms are consistent with anemia from active ulcerative colitis. A hemoglobin of 9.7 g/dL is low and easily explains the severe fatigue, weakness, and reduced exercise tolerance you are experiencing. Yes, anemia can occur without gross visible blood in the stool. In ulcerative colitis it may be due to chronic microscopic blood loss from the inflamed lining of the colon, iron deficiency due to ongoing inflammation, and anemia of chronic disease due to inflammatory activity.

The CRP of 16 is elevated, suggesting that there is still active inflammation, even though the bowel frequency is only four to five times a day. This might be a mild to moderate flare rather than remission.

You are on Azathioprine and Mesalamine, appropriate maintenance therapies. However, with rising inflammation and anemia, your gastroenterologist should reassess disease activity.

Regarding iron treatment, oral iron tablets may help in mild iron deficiency. However, in many patients with active ulcerative colitis, intravenous iron infusion is faster-acting and better tolerated.

Your doctor may also order iron studies (ferritin, transferrin saturation) and possibly a stool calprotectin or repeat evaluation to assess the level of inflammation.

If fatigue persists, bleeding worsens or hemoglobin drops more, treatment may need to be changed to better manage the inflammation.

The important next steps are to verify iron deficiency, treat anemia and determine if your ulcerative colitis is going into a flare so therapy can be optimized.

If you found this information helpful, I would appreciate your feedback. Wishing you comfort and steady improvement ahead.

Thank you.