How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. D. Evans Your Own Question

Dr. D. Evans
Dr. D. Evans, Doctor (MD)
Category: Health
Satisfied Customers: 4464
Experience:  MS in ENT and Head and Neck Surgery , Attachment to Neurosurgery.
1771736
Type Your Health Question Here...
Dr. D. Evans is online now
A new question is answered every 9 seconds

woman in thirties has anaemia and after exhaustive medical ...

Resolved Question:

woman in thirties has anaemia and after exhaustive medical tests cannot find reason. Has had one blood transfusion, cannot tolerate iron injections, has had iron infusions three times and is now finding she is finding these are followed by intense headaches and heart pain
Submitted: 6 years ago.
Category: Health
Expert:  Dr. D. Evans replied 6 years ago.
Hi,
Since you are online, could you please give some more information:

How long has she had this anemia?

What is her level of hemoglobin?

Has she had bone marrow examination?

I am available online to help you further after I get this info.
Customer: replied 6 years ago.
her hemoglobin has been as low as 93g/L
she has not had bone marrow scan, has had wireless capsule endoscopy,colonoscopy, pelvis scanned, has a gallstone.
no koilonychia,no oddema, chest clear abdomen soft, non-pigmented stria and diffuse low abdominal pain.
Has been treated since Nov 2006, patient feels she has been suffering lethargy and breathlessness for sometime.
Has had gastroscopy with duodenal biopsy normal
Expert:  Dr. D. Evans replied 6 years ago.
Some important causes of anemia like bleeding from the intestines, intrinsic factor deficiency, etc. have been eliminated.

I would suggest that you consult a hematologist. A hematologist is a specialist in blood diseases.

Persistent anemia needs to be investigated further.

Other causes of anemia for which she needs investigation is to find out whether there is any bone marrow suppression. For this she would need a bone marrow aspiration.

Her type of hemoglobin also needs to be evaluated, with a full hemogram.

For all this, you should consult a hematologist. You should discuss about bone marrow aspiration with him.

Once the cause of the anemia is found, this cause can be treated.

There are many causes of anemia, icluding renal diseases, etc. All these need to be investigate for and ruled out.

You can look up here:
http://www.emedicine.com/med/topic132.htm



I hope this answer was helpful. If you need more information, feel free to ask. For accepting this answer, please click on the green 'accept' button below. Feedback/Bonus will be warmly appreciated.

Customer: replied 6 years ago.
In regard to renal diseases and anemia, what symptoms would she present and would not her specialists have taken this into consideration.
I agree that she should consult a hematologist.What treatment would follow once her type of hemaglobin had been evaluated.
She is intolerant to gluten and can tolerate goats milk but not cows milk. This was not a problem when she was in her teens and early thirties. She is allergic to fish, shellfish
Expert:  Dr. D. Evans replied 6 years ago.
Yes, her specialists might have screened her for renal disease, but it cannot be said for sure. You should check this out with them.

Anemia is often the first sign of a renal disease, so she might not have any other symptom.

But of course there are many other causes. SInce she has already been investigated and treated, without any permanent cure, I would suggest that you consult a hematologist.

Gluten intolerance might cause nutritional anemia if she has not been taking a proper diet due to this, otherwise it would not cause anemia directly.



I hope this answer was helpful. If you need more information, feel free to ask. For accepting this answer, please click on the green 'accept' button below. Feedback/Bonus will be warmly appreciated.
Customer: replied 6 years ago.
thanks for your answer but you did not comment on my question in regard to what treatment would follow once her type of haemoglobin had been evaluated,i.e
Expert:  Dr. D. Evans replied 6 years ago.
As I said, it will depend on the cause of her anemia.

If it is determined to be nutritional, then nutritional correction will suffice.

If it is found to be due to bone marrow suppression, steroids, etc. will be needed.

If she has an abnormal hemoglobin, then she will again need other supplements.

So the first thing is to find out the cause of the anemia. The treatment will depend on the cause. There is no common treatment, individual treatments will vary depending on the cause.



I hope this answer was helpful. If you need more information, feel free to ask. For accepting this answer, please click on the green 'accept' button below. Feedback/Bonus will be warmly appreciated.

Customer: replied 6 years ago.
thanks for your reply, will follow up on your suggestions, should we finally find a solution would it be possible to contact you through this site to let you know the outcome?
Expert:  Dr. D. Evans replied 6 years ago.
Yes of course.

You can follow up on this question from the email in your inbox or you can ask a new question and begin with:For Dr. Evans.



I hope this answer was helpful. If you need more information, feel free to ask. For accepting this answer, please click on the green 'accept' button below. Feedback/Bonus will be warmly appreciated.
Dr. D. Evans, Doctor (MD)
Category: Health
Satisfied Customers: 4464
Experience: MS in ENT and Head and Neck Surgery , Attachment to Neurosurgery.
Dr. D. Evans and 3 other Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery