Anaemia

[missrandom]

Hi
I have, at long last been refered to a haemotologist as I have been anaemic on and off for years. This time however, despite high dosages of iron, my levels are still low (only a littel bit). I had a TIBC and that showed normal.
I was just wondering if anyone else has had a similar experience, if so what was the outcome?
cheers

[sqad617]

The question that comes to mind is are you bleeding....e.g piles, heavy periods etc.

Normal FBC rules out anaemias other than iron deficiency anaemia, so don't worry.

[missrandom]

well no, thats the mystery, I dont appear to have bleeding anywhere and my periods are normal at the moment. They had been heavy in the past, but for the past 6 months or so i've been taking between 200mg and 400mg of iron a day and it hasnt moved. So long as its nothing nasty :-)

[sqad617]

OK...then the next question is....are you absorbing iron?
The haematologist will possibly do further blood tests and perhaps a sternal marrow puncture, but I cannot think of anything nasty.

[missrandom]

ouch that bone marrow thing sounds like it would hurt? So it couldnt be anything like leukemia (my aunt died at 42 with it), although I'm only 29. I suppose i'd be ill with something like that wouldnt I? I mean i'd feel ill, and I dont.

[LazyGun]

One would hope that the cause has been identified for your IDA, especially if you have clinical symptoms of anaemia, such as being tired all the time, or feeling out of breath etc. In essence, IDA is caused by;
1. Insufficient iron intake ( ruled out in your case if you have been taking supplementary iron)
2. Long term bleeding condition - Long or very heavy menstrual periods, bleeding fibroids in the uterus, a bleeding ulcer or colonic polyp. Long term blood loss is sometimes associated with long term use of non steroidal anti inflammatory drugs such as ibuprofen, or pain relief medication such as aspirin.
3. Hereditary dysfunction of the red blood cells, such as B- Thalassaemia, Sickle Cell anaemia, etc
The TIBC being normal really just illustrates that your body has the capacity to transport a sufficiency of iron, so the anaemia it isnt a metabolic or hereditary misfunction of transferrin or the liver where it is produced.
4. Absorbtion of Iron. The regulation and uptake of iron from the gut into the blood stream is still not fully understood - impaired gastic acid production can for instance reduce iron uptake, and certainly from what you have described to date I would think the problem might lie in this area.

I would be concerned, were I in your shoes, to establish the underlying reason for the anaemia as a priority, so that can be addressed , as soon as possible.

[sqad617]

Hb, lowish, FBC normal, it is NOT leukaemia.

[LazyGun]

Any leukaemia sufficiently advanced to cause a chronic iron deficiency anaemia should almost certainly show blood cell abnormalities that would be picked up very quickly in the Full Blood Count so I would seriously doubt that leukaemia is the cause.

[missrandom]

I did have a coeliac test and one that indicates inflammation (i supose for crohns), as my mum has crohns, but both were fine. I do have Gilberts syndrome, as I often have high levels or bilirubin, but have been told that Gilberts doesnt cause any problems at all.
Your all very knowledgeable:-)

[sqad617]

Knowledgable?...LOL not really although lazygun has given you quite an errudite and accurate account. I cannot see that Gilbrert.s Disease would lower your Hb, and really it doesn't sound as though you have Crohns Disease and certainly not Coeliac Disease. Stop worrying and as lazygun says "get it sorted"

[missrandom]

well, ive just got to wait for the apt now, so about 8 weeks on the nhs.
thank you (and i think your knowledgeable...on this anyway, lol)
x

[bednobs]

have you had a coombes test? (this is for Auto immune haemolytic anaemia)

I myself was in the same position as you last year - chronically low hb (below 8) not being affected by iron, No signs and symptoms of bleeding at all

[missrandom]

no, i dont think i have, I suppose the heamotologist will do it when I see her.
Do you have to take anything for that?
My iron hasnt been that low in a long time, but then i have been on iron, when i leave it and leave it, itgoes low.

[bednobs]

sorry i didnt really finish - no it wasnt that after all, and in fact it was a gastric bleed. I was so surprised as i had absolutely no signs of bleeding, feeling ll, no black poo, no vomitting blood, nothing! - however a gastroscopy showed a bleding lesion

[Eve]

I was going to suggest something gastric related.

You say they've ruled out Crohns but could be something similar causing malabsorbtion and possible bleeds from ulcers etc...

Did they just do blood tests re Crohns, esp if you mum has it eg ESR, CRP, ANA etc... have they not done a camera up or down to check you out that way?

I'd still keep something gastro in mind. Do you have any gastro symptoms? If not, unlikely, but worth a question.

[missrandom]

Jenna -yes they only did the one blood test and my mum had years of problems before they diagnosed crohns, when she was about 45 (she's not your typical crohns sufferer either - she says she's the only overweight person shes seen with crohns, much too her annoyance, lol).

Bednobs - there was talk of further inestigations but my doc said , that would be avoided if poss, as its not nice. Bet that was a shock for you, how did they "fix" the problem?

[bednobs]

they injected the bleeding area with something, cant quite remember as i was a bit woozy when they were telling me, and then put me on tablets for it