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Dr Khan
Dr Khan, Doctor
Category: Medical
Satisfied Customers: 1183
Experience:  MB, MRCP(UK), MCPS(Medicine)
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High RDW CV (17.9), normal RDW SD (40.5), low MCHC (27) and MCV (61), normal platelet (386

Resolved Question:

High RDW CV (17.9), normal RDW SD (40.5), low MCHC (27) and MCV (61), normal platelet (386), low hemoglobin (7.4), low hematocrit (28), low ferritin (2), white blood cell count (7.5), red blood cell count (4.5). Test after test, after answers. No bleeding issues, normal colonoscopy, normal upper GI, capsule GI with small abnormality, but that is after regular other tests, so this is a new symptom. Normal blood occult, normal periods and now on depo-provera to stop having them due to how anemic I am. I have had one blood transfusion in over a year ago, and had difficulty accepting the blood. I have not been able to take any iron supplements that my body will accept; all make me sick to my stomach and none will stay in my system. Iron infusions no longer work as I am so sensitive that when they start the infusion, I have great difficulty breathing and no amount of steriods or benadryl will help. I am extremely tired at all times, dizzy spells,nail&teeth issues.
Submitted: 5 years ago.
Category: Medical
Expert:  Dr Khan replied 5 years ago.

Hello and Welcome to JA
Thank you very much for your question and coming to this service

Any haemoglobin electrophoresis or bone marrow biopsy done or considered by anyone?

Customer: replied 5 years ago.
As of this date, no. I have finally gotten Hematology to agree to let me see a new doctor, I will see this person on this coming tuesday, hopefully i will also get a blood transfusion as I am having great difficulty now.
Expert:  Dr Khan replied 5 years ago.

Yes I can understand that with a level of 7.4 Hb it will be quite difficult for to cope with even daily routine

May I please ask before answering that what explanations have been offered so far?

Do you have any diarrhea or other medical issues?

Customer: replied 5 years ago.
I am looking for even an idea of what may be wrong as I have gone through so much with a lot of headaches from the NP that I have been dealing with in Hematology since 2006. She feels all my troubles are low iron related and will do no testing, complains that I am being weak when I cannot breath and have to stop the iron infusions. I managed to get one blood transfusion over a year ago and this was done begrudgingly through her ok. She fought me over getting in to see a new doctor, but my primary doctor helped convince Hematology that something was wrong and that I was owed a second opinion. The GI doctor has been disturbing as well, mentioning bleeding issues and positive blood stool findings when there were NONE, and never have been any. I have done so many GI tests that I can't count any more and I feel his is more in this for the insurance money, always pushing to do yet another test. I have great difficulty with the anesthesia that is being used (I know that I can tolerate others, I've had good results with tonsils being removed - just a few years ago- and with an ER appendicitis) and feel so awful from it that I thought I was going to die the last time, my BP skyrocketed and I had severe restlessness issues that lasted over 12 hours. He won't talk about anything and I just keep getting calls and letters reminding me that I have to come in for more GI scope tests and they want to "eventually" do a surgery to see what the small abnormal item in the GI capsule was. It worries me. I have no diarrhea issues. I have hypo-thyroid disease. I also have fibromyalgia, which was brought on at the same time as the thyroid condition, which was due to a severe car accident which caused a very bad snap to my neck and continues to cause issues with C2,C3 and their reverse curve affects C5. I also have shattered discs in my lower back, which IDET did not help. I take 300mcg of levothyroxine each day as well as 60mg of morphine sulphate [email protected], for the last 10 years. I follow a pain management doctor for this medication.
Expert:  Dr Khan replied 5 years ago.

Thank you very much for the details
As it appears from your red cell indices that you have anemia due to low iron levels apparently but no source has been identified to date despite a search

Here I can offer a few suggestions

First about iron supplements

You can try them in between meals to avoid stomach effects

Taking Vit C with it will enhance absorption

You can have foods rich in iron to help increase levels like liver, kidney, chicken and turkey, tripe, shellfish, lean meat, fish

You can take acid suppressing therapy with it like Omeprazole which will reduce stomach side effects and increase tolerability

Second regarding underlying reason

Sometimes hidden sources like angiodysplasia of intestine causing small oozing of blood chronically can be the culprit and should be considered

I would also consider couple of other conditions which can cause similar picture like thalasemia trait and sideroblastic anemia for which haemoglobin electrophoresis and a bone marrow biopsy would be needed

Besides these possibilities almost all have been excluded in your case which can give rise to this picture so i will make sure that they are not the culprit

Let me know if any further queries

Best Regards

Customer: replied 5 years ago.
Have tired all your options for iron absorption, but for whatever reason, my body simply will not accept iron. I eat a very good diet, with no soda, no caffeine (a rare coffee drink, decaf, realize there is a small amount of caffeine in decaf), lots of fish, no fried foods, very rarely eat red meat, eat veggies, fruits and legumes, drink tea and lots of water. The last tests showing my intestines revealed that I have very healthy intestines, my doc said they were that of a much younger woman, even though they found the small abnormal lump, but thought it was more likely a fold of the intestines rather than a tumor. The doctors have ruled out Beta Thalasemia and minor as well. That is a great part of what is so frustrating about this. I have had issues with lower degrees of anemia my entire life; my adopted mother told me recently that I had been positively diagnosed with anemia when I was young, several times. It has been on and off as an adult, but since my last child in 2007, I have been suffering greatly.
Expert:  Dr Khan replied 5 years ago.

Then likely either we are dealing with some abnormal haemoglobin other than thalasemia like haemoglobin C and S or some defect of iron utilization in marrow

My best advice here would be to get an appointment with a haematologist (as you are already doing) but at some big university hospital which is near you

Here you will have more detailed and definite opinion and if any sophisticated tests are needed those can be done also like for example sometimes when suspicion is strong we get labeled red cell scans to pick the bleeding source when all apparent labs are normal , so this would be your best bet

Let me know if any further query

Best Regards

Dr Khan and 2 other Medical Specialists are ready to help you
Customer: replied 5 years ago.
Thank you. :O)
Expert:  Dr Khan replied 5 years ago.

Pleasure is all mine

Please dont forget your valuable + feedback

Warm Regards