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What Causes Hemoglobin Level In Blood To Drop When Treating Iron Deficiency Anemia?

Posted on Sat, 23 Jan 2016

Question: Hi Doc! I am attempting to sort out the cause of my iron deficiency anaemia. A recent colonoscopy indicates 1 cm of thickening at the Ilium (down from 3 cm), and my GI health has been very good in the last few months. I've had a hysterectomy. My Haemoglobin has been dropping by approx 20 points per month (currently 77), even though I receive monthly IVs of Iron Dextran (1000 mg).

Answered by Dr. Shailja Puri (46 minutes later)

Brief Answer:
Iron loss can lead to iron deficiency despite taking supplementsl

Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.

A fall in hemoglobin despite taking iron supplements suggests that either there is iron loss which is much more than the intake or there is another cause of low hemoglobin or anemia.
I suggest you to get iron studies done, which includes iron, TIBC, transferrin saturation and ferritin.
Besides iron deficiency, low levels of vitamin B 12 and folic acid can also lead to low hemoglobin or anemia.
Thus, level of vitamin B 12 and folic acid should also be monitored in blood to assess their levels.
If iron level is low, then the cause of loss of iron in body needs to be determined and thus treated.
A 3 cm thickening in ileum needs to be biopsied to know the nature of lesion.
Thickening of ileum is a remote possibility and biopsy will be required to look for the changes.
I suggest you to consult a gastroenterologist for endoscooy if clincally require

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Shailja Puri (2 hours later)

Hi Doc, my B12 levels have remained in the norm range at each testing. Iron studies are done monthly, and though the cells are small the general consensus by GP is that they are small due to the monthly IVs.

The 1 cm thickening has been biopsied, and results will be in soon. I do not feel Crohn's is the issue. Celiac was ruled out some time prior.

Perhaps premature death of RBCs, RBCs not living to maturity, or malabsorption...?

Answered by Dr. Shailja Puri (9 hours later)

Brief Answer:
Normal iron level rule out malabsorption and iron loss from body.

Detailed Answer:
Hello and welcome again,
Vitamin B 12 and iron levels are normal so iron deficiency is ruled out.
The possibility of malabsorption is also ruled out because iron malabsorption will lead to low iron in blood.
In case there is loss of iron from body due to any cause, the iron level will again be low.
Normal iron levels in blood rule out malabsorption or iron loss from body.
There is another entity called anemia of chronic disease wherein iron level is normal but hemoglobin level is low.
It would be helpful if you could post the iron and B 12 report for analysis.
The biopsy report of intestinal lesion may also be posted if reported.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shailja Puri (14 hours later)

Hello Dr. Puri - Unfortunately I don't have my B12 level results handy, but was told they were in normal range each time they were tested. I have, however, uploaded 6 months worth of test results.

Without iron infusion, my haemoglobin & ferritin levels do not remain in normal range. The 6 months' test results are indicative of monthly infusions, generally 1000mg of iron dextran.

As to intestinal lesion, there has not been a lesion found only redness & thickening at the terminal ilium.

Thanks for you assistance
xxxxxxxxxxx

Answered by Dr. Shailja Puri (9 hours later)

Brief Answer:
The ranges for iron variables needs to be known.

Detailed Answer:
Hello and welcome again,
The normal range for iron is 11-31 millimoles/L and TIBC is 45-82 millimoles/L.
According to these ranges, iron level is low and TIBC is within range.
However, different laboratories follow different ranges.
It would be helpful if you could post the ranges followed by your laboratory for accurate interpretation.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shailja Puri (11 hours later)

I do not believe the lab will provide this information to me. Based on the data provided, is there anything else I should be pursuing?
For example, what tests would need to be performed to ensure the RBC is making it to maturity, and completing a normal life span?
What other tests would be required to ensure the iron received from food & supplements is absorbable?

Answered by Dr. Shailja Puri (1 hour later)

Brief Answer:
Iron is rich in non-veg foods, RBC maturity can be assessed on PBS.

Detailed Answer:
Hello and welcome again,
The best way to assess that the red blood cells is making up to maturity and is not destroyed before its normal life span is get few tests done.
These tests are: Total bilirubin, LDH, red cell morphology on peripheral blood smear (PBS) and radioactive tagging of red blood cells.
If all these tests are within normal range, the red blood cell life span is normal.
The best iron source are from non-vegetarian sources especially meat.
The iron from non-vegetarian sources has good absorption from gastrointestinal tract.

Thanks and take care
Dr Shailja Puri

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Above answer was peer-reviewed by : Dr. Raju A.T