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What Do These Following Blood Reports Indicate?
Question: My mother (58+ Y) is under treatment for Hypothyroidism (Eltroxin 50 mcg), Hypertension (Olmezest 20mg) & Osteoarthritis (stage-2) of knee joints (Gemcal D3). Her Hb had been quite steady over past 3-5 years (11.7 - 12.1), however, we have seen drops to 10.5 couple of times in past 2-years, as explained in details below.
In late 2015 she was diagnosed with Hb 10.6, Ferritin 39, B12 498, however, it improved to 12.4 within 2-months of daily 'Orofer XT' & 'Ecod Plus'. After that she was advised to take 'Orofer XT' once a week (due to frequent gastritis) & Hb was 12.0 after 4 more months, after which 'Orofer XT' was stopped completely.
In mid 2016 she was again diagnosed with Hb 10.7 (after 4-5 months of stopping 'Orofer XT'), Ferritin 83, B12 894, Serum Folate 12, RBC Folate 883. She was also undergone a routine stool examination, which indicates occult negative with traces of mucus & no ova or cyst. She was therefore put on daily 'Uprise XT' & 'Folvite', however, even after 3-4 months of medication, Hb has just improved to 11.2. I've also attached CBC reports before & after medication for your kind review.
Few other lab reports -
serum BUN - 14
serum Creatinine - 0.8
TSH - 3.75
Vit D - 43
FBS - 97
Iron profile reports are as follows -
serum iron - 56
TIBC - 255
UIBC - 199
TSI - 22%
Retic Count - 1.2%
I therefore request your kind feedback on whether or not we are on the right track of treatment. Is this really a case of iron deficiency or something else ?
In late 2015 she was diagnosed with Hb 10.6, Ferritin 39, B12 498, however, it improved to 12.4 within 2-months of daily 'Orofer XT' & 'Ecod Plus'. After that she was advised to take 'Orofer XT' once a week (due to frequent gastritis) & Hb was 12.0 after 4 more months, after which 'Orofer XT' was stopped completely.
In mid 2016 she was again diagnosed with Hb 10.7 (after 4-5 months of stopping 'Orofer XT'), Ferritin 83, B12 894, Serum Folate 12, RBC Folate 883. She was also undergone a routine stool examination, which indicates occult negative with traces of mucus & no ova or cyst. She was therefore put on daily 'Uprise XT' & 'Folvite', however, even after 3-4 months of medication, Hb has just improved to 11.2. I've also attached CBC reports before & after medication for your kind review.
Few other lab reports -
serum BUN - 14
serum Creatinine - 0.8
TSH - 3.75
Vit D - 43
FBS - 97
Iron profile reports are as follows -
serum iron - 56
TIBC - 255
UIBC - 199
TSI - 22%
Retic Count - 1.2%
I therefore request your kind feedback on whether or not we are on the right track of treatment. Is this really a case of iron deficiency or something else ?
Brief Answer:
Some iron deficiency is there
Detailed Answer:
Hi
Thanks for your query.
Iron deficiency has been proven in her, though currently the levels are borderline low only. The hemoglobin is also not alarmingly low. Even if she maintains in this range, I would be happy. Oral iron supplements are erratically absorbed and hence she is never able to build up her iron stores to normal level.
We can consider a shot of IV iron which will bypass the gastric absorption route and bring iron stores to normal. As she has remained stable over the years and stool is negative for occult blood, possibility of any gastrointestinal problem leading to blood loss and chronic iron deficiency is less likely.
Given her course over time, and normal white cell and platelet count, I would not consider other causes of anemia.
Hope this helps.
Regards
Some iron deficiency is there
Detailed Answer:
Hi
Thanks for your query.
Iron deficiency has been proven in her, though currently the levels are borderline low only. The hemoglobin is also not alarmingly low. Even if she maintains in this range, I would be happy. Oral iron supplements are erratically absorbed and hence she is never able to build up her iron stores to normal level.
We can consider a shot of IV iron which will bypass the gastric absorption route and bring iron stores to normal. As she has remained stable over the years and stool is negative for occult blood, possibility of any gastrointestinal problem leading to blood loss and chronic iron deficiency is less likely.
Given her course over time, and normal white cell and platelet count, I would not consider other causes of anemia.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr. XXXXXXX for your response. Request your kind opinion for the queries mentioned below -
1) Do you see any risk of tumor or malignancy here ? I was worried about the fact that even after 3-4 months of 'Uprise XT' & 'Folvite' Hb is only improved from 10.7 to 11.2, while Ferritin level being 83.
2) How long do you recommend to continue the iron supplements ? Should we stop it now or, continue until Hb reaches 11.5 or 12.0 ?
1) Do you see any risk of tumor or malignancy here ? I was worried about the fact that even after 3-4 months of 'Uprise XT' & 'Folvite' Hb is only improved from 10.7 to 11.2, while Ferritin level being 83.
2) How long do you recommend to continue the iron supplements ? Should we stop it now or, continue until Hb reaches 11.5 or 12.0 ?
Brief Answer:
Please refer below
Detailed Answer:
1. Risk of malignancy low because overall no worsening over 2 years. The iron stores are quite low still, suggesting poor absorption which happens sometimes.
2. Iron can be continued as the body stores reflected by ferritin are quite low. Alternatively one shot of IV iron can be given.
Please refer below
Detailed Answer:
1. Risk of malignancy low because overall no worsening over 2 years. The iron stores are quite low still, suggesting poor absorption which happens sometimes.
2. Iron can be continued as the body stores reflected by ferritin are quite low. Alternatively one shot of IV iron can be given.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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