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. However, in the past two weeks, I have been experiencing extreme fatigue, which is more concerning than my bowel issues. I have bowel movements about four to five times a day, but I feel exhausted, to the point where I struggle to climb stairs.

I recently had a blood test, and my hemoglobin level came back at 9.7 g/dL, which 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 take iron tablets or get an iron infusion?
Additionally, how can I determine if my condition is experiencing a mild flare or if something more serious is happening internally?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns.

Your symptoms are concerning for anemia associated with active ulcerative colitis. A hemoglobin of 9.7 g/dL is indeed low and can easily explain the severe fatigue, weakness, and reduced exercise tolerance you are experiencing.

Yes, anemia can occur even without obvious visible blood in the stool. In ulcerative colitis, it may develop from chronic microscopic blood loss from the inflamed colon lining, iron deficiency due to ongoing inflammation, and anemia of chronic disease caused by inflammatory activity.

Your CRP (C-reactive protein) of 16 suggests that there is still active inflammation, even though bowel frequency is only four to five times daily. This may represent a mild to moderate flare rather than complete remission.

You are currently taking Azathioprine and Mesalamine, which are 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 increases, or hemoglobin falls further, treatment may need to be adjusted to better control the inflammation.

The key steps now are confirming iron deficiency, treating anemia, and evaluating whether your ulcerative colitis is entering a flare so therapy can be optimized.

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

Thank you.