Brief Answer: Cause could be medications Detailed Answer: Hello sir and welcome. Thank you for writing to us. I shall address each of your parameters individually in order to clear your doubt adequately. Following is the information: -Hemoglobin (HGB): Very close to the lower limit of normal. Cause could be related to simple anemia or a liver condition, as suspected below -Hematocrit (HCT): Very close to the lower limit of normal. Cause could be related to simple anemia or a liver condition, as suspected below -ALT: Mildly elevated -GGT: Mildly elevated. Causes for such a presentation in my opinion are the following: -Medications: As almost all the medicines are metabolized by the liver, some of them affect the liver causing a change in liver function (e.g cholesterol medication, anti-fungal, non-steroidal anti-inflammatory drugs, anti-depressants, anti-epileptics, testosterone, etc.) -Alcohol consumption -Cardiac condition (less likely) The medications that you are on could very well be the cause for the change in your parameters. But I would also advise an ultrasound of the abdomen and pelvis to look into the liver and look for abnormalities. I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.

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Brief Answer: Bleed should be suspected when anemia is seen Detailed Answer: Hello sir. Yes, it could be related to the medication or the anemia. The anemia will have to be corrected and then see if the symptoms still last, but if they disappear then the cause could have been the anemia; if not, then the cause could be the medications. I somehow feel that all of this could be the anemia, as this was diagnosed in the past, and all your symptoms coincide with anemic symptoms. So I would recommend correction of the anemia. Correction of anemia is usually done with the help of: -Vitamin and iron supplements -Blood transfusions (advised only for very low hemoglobin levels) The scopes are a good option and would be something I recommend as a bleed should always be suspected and ruled out or diagnosed whenever anemia is seen. So please do go ahead with these. As for any special information you need to provide the specialist or request for, there is nothing really. Just inform him/her about the long standing anemia, that should suffice. You are most welcome. I really hope you find this information helpful. I am always available to be of assistance. Best wishes.

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