Hello and Welcome to JAThank you very much for your question and coming to this service
Any haemoglobin electrophoresis or bone marrow biopsy done or considered by anyone?
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?
Thank you very much for the detailsAs 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
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
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