advice needed: anemia case 
Author Message
 advice needed: anemia case


Dear Colleague,

this is my son's medical history. He has severe iron-deficient unexplained
anemia for more than two years.  All tests shows heavy iron deficiency. We
cannot find any source of bleeding (he had five gastroscopies,
two colonoscopies, rectoscopy, intestine X-ray, CT-scan). The results of
tests for occult {*filter*}: most of  them are negative, but episodically they
are very slightly positive (this test designed for feces, but
occasionally I ran it for water after movement and result was positive and
it's always positive with water).
Two or three times he saw small amount of fresh {*filter*} on the paper after
defecation (but immediate recto-  and colonoscopy didn't expose the reason
for bleeding). There is no {*filter*} in urine. At the beginning of
examination (about 2 years ago) high titre of antibodies to ierseniosis
was exposed (he had no symptoms  of this decease). He has aberrant lobe of
pancreas and only one kidney.

He had several courses of iron therapy, but short time after it's
finishing his Hb fell down dramatically.  Last time he has been taking 325
mg of iron sulfate x 3 times a day for 6 months. His hemoglobin became
normal (136), but serum iron and ferritin were still low - 5.6 and 55
(normal range - 10-23 and 80-230,  correspondingly). One month after he
stopped taking iron, his Hb fell down to 85 (normal range 130-160).
He started taking iron again, but several months later his Hb was only
106.  He has all symptoms of  anemia: dispnoe, palpitation, etc. He loses
his hair. He always has low or borderline serum level of
cholesterol. All other {*filter*} tests, including profile of hemoglobins, are
normal. Month ago he stopped  taking intramascular ferrum. 2 weeks later
his Hb was 127, ferritin - 327 (normal range 80-240), serum
iron 21 (normal range 25-35). Now his Hb is 120, serum iron 8.9 (normal
range 14-25). He has light symptoms of anemia again.

I ask you very much to help me to understand what is the reason of iron
deficiency in my son? What could be the cause of his anemia?
What kind of methods exists in order to establish the fact and the
source of bleeding besides the methods he has already had?

Thank you very much for any help.

Sincerely yours

                                Margarita Anshina, M.D.
                                Russia, Moscow    




Thu, 01 Jul 1999 03:00:00 GMT
 advice needed: anemia case

On Sun, 12 Jan 1997 11:56:07 -0800, Dmitri Kossakovski

Quote:


>Dear Colleague,

>this is my son's medical history. He has severe iron-deficient unexplained
>anemia for more than two years.  All tests shows heavy iron deficiency. We
>cannot find any source of bleeding (he had five gastroscopies,
>two colonoscopies, rectoscopy, intestine X-ray, CT-scan). The results of
>tests for occult {*filter*}: most of  them are negative, but episodically they
>are very slightly positive (this test designed for feces, but
>occasionally I ran it for water after movement and result was positive and
>it's always positive with water).
>Two or three times he saw small amount of fresh {*filter*} on the paper after
>defecation (but immediate recto-  and colonoscopy didn't expose the reason
>for bleeding). There is no {*filter*} in urine. At the beginning of
>examination (about 2 years ago) high titre of antibodies to ierseniosis
>was exposed (he had no symptoms  of this decease). He has aberrant lobe of
>pancreas and only one kidney.

>He had several courses of iron therapy, but short time after it's
>finishing his Hb fell down dramatically.  Last time he has been taking 325
>mg of iron sulfate x 3 times a day for 6 months. His hemoglobin became
>normal (136), but serum iron and ferritin were still low - 5.6 and 55
>(normal range - 10-23 and 80-230,  correspondingly). One month after he
>stopped taking iron, his Hb fell down to 85 (normal range 130-160).
>He started taking iron again, but several months later his Hb was only
>106.  He has all symptoms of  anemia: dispnoe, palpitation, etc. He loses
>his hair. He always has low or borderline serum level of
>cholesterol. All other {*filter*} tests, including profile of hemoglobins, are
>normal. Month ago he stopped  taking intramascular ferrum. 2 weeks later
>his Hb was 127, ferritin - 327 (normal range 80-240), serum
>iron 21 (normal range 25-35). Now his Hb is 120, serum iron 8.9 (normal
>range 14-25). He has light symptoms of anemia again.

>I ask you very much to help me to understand what is the reason of iron
>deficiency in my son? What could be the cause of his anemia?
>What kind of methods exists in order to establish the fact and the
>source of bleeding besides the methods he has already had?

>Thank you very much for any help.

>Sincerely yours

>                                Margarita Anshina, M.D.
>                                Russia, Moscow    



For that rapid a development of anemia, if he was losing {*filter*} in the
GI tract, I'd expect his stools to be strongly positive for occult
{*filter*}.  You are left with either idiopathic pulmonary hemosiderosis (a
Chest X-ray would help make that a plausible diagnostic route), or
hemoglobinuria (paroxysmal nocturnal hemoglobinuria), for which a
urinary hemosiderin might be a clue.  You might also have to consider
factitious disorders, such as {*filter*}letting--or selling his {*filter*} at a
{*filter*} bank in between treatments.  In some parts of the US, we see
iron deficiency anemia as a result of intestinal hookworm infestation,
but I'm not sure if the stool is guaiac + or - in that disorder.  H2


Fri, 02 Jul 1999 03:00:00 GMT
 advice needed: anemia case


Quote:
>this is my son's medical history. He has severe iron-deficient unexplained
>anemia for more than two years.  All tests shows heavy iron deficiency.

Has the boy been tested for gluten intolerance, aka celiac disease? Iron
anemia is probably the number one symptom of this condition. This is
because iron is absorbed in the first part of the intestine, and that is
the part that the gluten damages first. For some it was the only symptom
present. Taking supplements may be treating the symptom, but it is not
addressing the underlying cause.

Here are some anecdotes from people that learned they had celiac disease
after being rejected when trying to donate {*filter*}:

Date:    Wed, 16 Oct 1996 14:40:55 EDT


Subject: {*filter*} donation

In the past (before Celiac diagnosis) I had been a regular {*filter*} donor, in
fact that is how I began to find out I was a Celiac. Does anyone have any
information regarding the advisability as to {*filter*} donation from Celiacs ?

=======================

Date:    Tue, 22 Oct 1996 14:58:18 EDT


Subject: {*filter*} donation results

Below is a listing of the responses I have received regarding CD and {*filter*}
donations. [donating responses edited out here...]
----
I also found that I had celiac as a result of being a {*filter*} donor (three
years ago); my iron level slowly decreased to the point that the {*filter*} bank
sent me to my doctor to resolve the anemia problem.
----
I'm in the same boat as you are -- I had been deferred by the Red Cross
twice for anemia before going to get checked out by an internist and
then a GI.  
----
My path into a gluten-free diet also started when I went to the Red Cross
clinic to donate {*filter*}, as I had many times over the years, and was told
that my iron was low. Went to my family doctor, then a GI, had some tests
including a biopsy which confirmed the need for a GF diet.
----

Quote:
>The results of
>tests for occult {*filter*}: most of  them are negative, but episodically they
>are very slightly positive (this test designed for feces, but
>occasionally I ran it for water after movement and result was positive and
>it's always positive with water).

The New England Journal of Medicine has an article in the May 2, 1996 issue
on "The Prevalence of Occult Gastrointestinal Bleeding in Celiac Sprue",
see:

  http://www.***.com/

Occult Bleeding also has correspondence:

  http://www.***.com/

Celiac disease can be controlled with a gluten-free diet. For more
information on gluten intolerance this page points to all Net resources:

  The Gluten-Free Page:   http://www.***.com/ ~donwiss/

Don.



Fri, 02 Jul 1999 03:00:00 GMT
 advice needed: anemia case

Dmitri, please have your son tested for thalassemia.  Two of my children
have it, and it went undetected in both for quite a long time because
their pediatrician was so positive it was anemia.  I hope this helps
you.

Pat (in beautiful southeast Tennessee, USA)



Sat, 03 Jul 1999 03:00:00 GMT
 
 [ 4 post ] 

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