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What causes dip in HB level leading to exterme fatigue and breathlessness?

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Practicing since : 2004
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Hi My sister's is complaining of exterme fatigue and breathlessness . Our GP suggested CBC amongst other tests. Other tests (liver kindey ) are normal except her Hb levels are prettly low (7.6) . I have attached the scanned copy of report. Next appointment is tommorow . After a week of iron pills and injects her Hb further dropped to 7.1. Her B12 is 211 . What could be the reason of this steep drop.
Posted Mon, 20 Jan 2014 in Blood Disorders
Answered by Dr. Indranil Ghosh 37 hours later
Brief Answer: Need to rule out blood loss or destruction Detailed Answer: Hi Thanks for your query. It appears that the cause of anemia is not due to iron or B12 deficiency. However, I am unable to see the scanned copy of the full report. In any case, we need to rule out any focus of blood loss, especially the uterus or gastrointestinal tract. A stool occult blood test will help. Also, sometimes there is excessive red cell destruction in the body, one of the causes being immune mediated. This can be tested with reticulocyte counts, coombs test, LDH, etc. please discuss this possibilities with her doc. You can send the reports to YYYY@YYYY . I will be available for further followup. Regards
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Follow-up: What causes dip in HB level leading to exterme fatigue and breathlessness? 9 hours later
Hi Doctor I have uploaded all the reports . Please suggest further course of action. I am going to do a stool occult test first.
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer: Yes, you should get that done Detailed Answer: i feel that other tests to rule out blood destruction is required as well as a bone marrow to rule out megaloblastic anemia (due to b12 or folate deficiency). Bone marrow also helps to rule out blood loss or destruction as in these, the bone marrow is normal (actually hyperactive to compensate for destruction or loss). If there is any production defect in bone marrow then that is also detected.
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