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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13834
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I recently had a blood test and was found to have normal levels

Resolved Question:

I recently had a blood test and was found to have normal levels if iron but low ferritin. I saw the doctor because of terrible fatigue which has continued for a few months. 12 years ago I had a nissen fundaplication which was a huge success. However recently I get pains at the very top area of my stomache Which radiates through to my back also have been getting bloating and wind. It is does not hurt to eat however more often hot or cold drinks feels as if they are burning as they go down (only sometimes). Is it possoble to have cancer although i have no blood in stools , no loss of weight or appertite My doctor would like me to have a colonoscopy and endoscopy but I cannot see that it is necessary when I have so few symptoms if anything

Your opinion would be appreciated
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
It will help if you could provide some further information:
Do you have the actual values of the ferritin and iron levels, including the iron saturation?
How long has it been since you went through menopause?

Customer: replied 1 year ago.

Ferritin level was 11 I don't know the other results other than they were normal levels I had a total hysterectomy at age 36 so never went through menopause

Expert:  Dr. D. Love replied 1 year ago.
In our reference lab, the normal range of ferritin extends down to 12. Do you know what the reference range for ferritin in this lab is?

Customer: replied 1 year ago.
No sorry I don't. May be they are worrying about nothing
Customer: replied 1 year ago.
I think iron was about 20. But a note at bottom of test said sources if blood loss should be considered
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.

Yes, it is possible that they may be worried about a minor issue regarding the ferritin, particularly if you are certain that an iron saturation was done and was normal. The level of iron in the blood could be normal in the setting of iron deficiency, but the iron saturation would typically be low and is more sensitive than the iron level.

As with many labs, a result that is only out of range by one point should be interpreted in the context of other clinical findings. A ferritin level that is normal, but low in the normal range, may be significant in a person with anemia and a low iron saturation. But in the case of someone with no anemia and a normal iron saturation, a minimally low ferritin may not be significant.

On the other hand, whether an endoscopy should be done for the abdominal and back pain that you describe is a separate issue, regardless of the level of ferritin, and it is recommended that everyone in your age group should have a screening colonoscopy, so I can understand why your doctor may have suggested these studies.

From the perspective of the abdominal and back pain, it would be reasonable to try a medicine that suppresses stomach acid to see if the pain improves, but if the pain persists, that would be a stronger indication that an endoscopy would be warranted.

To address your other questions, if a person has clear iron deficiency (a low iron saturation and ferritin), there should be further evaluation even if the tests for blood in the stool are negative. Iron deficiency in this setting is caused by chronic low levels of blood loss, and it typically does not happen all the time, so the stool blood tests could easily miss the blood. It is universally recommended that evaluation of the gut should be done on any man or post-menopausal woman that presents with iron deficiency, regardless of whether there is any documented blood in the stool or any symptoms present. I asked about menopause because we know where menstruating women are losing blood, and it may take some time after menopause for iron stores to be replenished. However, since you had the hysterectomy a couple decades ago, this is not an issue.

Therefore, it would be appropriate to confirm that the iron saturation was normal. If so, then the endoscopy or colonoscopy may still need to be addressed in the context noted above.

If you have any further questions, please let me know.

Customer: replied 1 year ago.
Thank you so much just to finish. Is it normal that the labs sending back the results write the comment that ' blood loss should be considered' when results are so near normal
Expert:  Dr. D. Love replied 1 year ago.
This would be an automated notation for any low ferritin level. It should not supersede the consideration of the entire clinical presentation, as noted above.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13834
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Dr. D. Love
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Family Physician for 10 years; Hospital Medical Director for 10 years.