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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Iron Deficiency In Blood

I just have a few questions about some fo my bloodwork and symptoms. I am a 24 y/o male. I currently am seeing a hem-onc regarding iron deficiency. My serum iron is 7 microg/dL, TIBC 460, transferrin sat 3%, and MCV 71.4. EGD and colonoscopy showed nothing, and Hemoccult negative for occult blood x2 separate occasions. I have been on p.o. iron for 5 months (serum feritin was 3 in nov 2010 and mar 2011 was 7). Also, celiac sprue panel negative. Hgb 13.8. All other blood tests and serum chemistry are normal. U/A was negative for blood. Retic count 2.5%. I have also had a couple of night sweats, spleen was 12 cm in 11/2010 and 14.5 cm in 2/2011, also I have 2 cervical lymph nodes (about 1cm each) enlarged just above clavicle. They are painless, but non-fixed and have been enlarged for about 8 weeks but have not increased in size. I have had no recent illnesses, except for strep throat in 12/2010 and glomerulonephritis shortly after that. I also have very bad exertional dyspnea since about october, to the point where I'm SOB after 2-3 minutes of minimal exercise (and i've been taking tae kwon do for 2 yrs without any trouble unitl recently). I also am extremely tired recently (I used to operate on about 5 hrs sleep/night and am now sleeping 12-15 hrs/day). I have never had any anemia or iron deficiency before. I have no family hx of blood cancers; however, my maternal grandmother had stage 4 breast cancer at 31 y/o and stage 2 breast cancer (which was unrelated to the first cancer) at 40 y/o. No family hx of iron absorption dz. My hematologist recommended IV iron dextran 1x per month x 4 months. Just wanted to know if I need a second opinion or is this just probably an iron absorption problem. Only past med hx is mild GERD. Currently taking nexium (for past 5 years ) and Bifera rx iron supplement (since nov. 2010).
Tue, 18 Aug 2015
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Pathologist and Microbiologist,  's  Response
Hello, I would suggest an FNAC fine needle aspiration cytology of your neck lymph nodes if they are still enlarged. I presume that you have had a peripheral blood smear evaluated by a hematopathologist. If not then peripheral blood smear examination is necessary. If you have not done certain tests such as TSH thyroid stimulating hormone test you may also get that done. Based on your description your condition appears to be iron deficiency anemia. The exertional breathless sensation may be a symptom of anemia. However as anemia is uncommon in a young male further work up is necessary especially that of your lymph node. A second opinion from a hematologist is prudent to exclude the possibility of a condition called lymphoma of your lymph node . Though it is a rare possibility it is prudent to get a second opinion. Best regards. Should you require further assistance in test interpretation please post your queries here.
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Suggest Treatment For Iron Deficiency In Blood

Hello, I would suggest an FNAC fine needle aspiration cytology of your neck lymph nodes if they are still enlarged. I presume that you have had a peripheral blood smear evaluated by a hematopathologist. If not then peripheral blood smear examination is necessary. If you have not done certain tests such as TSH thyroid stimulating hormone test you may also get that done. Based on your description your condition appears to be iron deficiency anemia. The exertional breathless sensation may be a symptom of anemia. However as anemia is uncommon in a young male further work up is necessary especially that of your lymph node. A second opinion from a hematologist is prudent to exclude the possibility of a condition called lymphoma of your lymph node . Though it is a rare possibility it is prudent to get a second opinion. Best regards. Should you require further assistance in test interpretation please post your queries here.