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Suggest Treatment For Iron Deficiency Anemia And Elevated Liver Enzymes

Posted on Wed, 6 May 2015

Question: My daughter, 42, just released from hospital. She is known to have iron deficiency anemia but has not seen a Dr. In a few years. Had needed iron infusions in the past. In ER, was found to have asymptomatic anemia with a Hgb of 3.5! She had 5 units of PRBCs and 2 units of FFP. She became jaundiced 2 days post transfusion with highly elevated Liver enzymes, low grade fever. She improved, is no longer jaundiced, liver enzymes came down dramatically and was discharged w/hgb of 7.5. Now she has increased belly size. Feels "like I have aweight belt around my waist." And has pain. No difficulty breathing, vital signs are stable. I think she's still having a delayed hemolytic transfusion reaction but should she go to the ER tonight? She has an appointment with a hematologist tomorrow at 1 pm.

Answered by Dr. Divakara (21 minutes later)

Brief Answer:
You can wait.

Detailed Answer:
HI'

Greetings from Dr.Divakara.P
Thanks for posting your query.

Yes your suspicion of delayed hemolytic transfusion reaction could be true . But I need to know it's been how many days since her last transfusion?

Most of the time hemolytic reactions will cause fever and dark colored urine . Both of these are not there . So it is either a mild transfusion reaction or something else . So in either case there is no emergency and you can wait till you meet your hematologist.

I would also recommend you to ask your hematologist to evaluate for the cause of such low Hemoglobin . If it is only due to Iron deficiency then find out the cause of Iron deficiency.

Hope this information was useful to you.
Any clarifications feel free to ask.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (14 minutes later)

Her transfusions were Friday, April 10. She had them all one after the other. She did have blood in her urine post transfusion and, like I said, jaundice, elevated liver enzymes, mild fever. The cause of her anemia is malabsorbtion from biliopancreatic duodenal switch 9 years ago. She doesn't absorb iron, calcium, and the fat vitamins.

Answered by Dr. Divakara (38 minutes later)

Brief Answer:
No need to go to ER.

Detailed Answer:
HI

Thanks for the information.

Then the chance of Delayed transfusion reaction is high but no need for an Er visit.

Also when you visit your hematologist get a repeat Liver function test and Ultrasound Abdomen scan too.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar