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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can NSAID Cause Anemia?

My mother-in-law has hiatal hernia, history of gastritis, HTN, chronic kidney disease, and anemia. She takes several medications including Mobic. Her RBC and Hgb has been slowly declining. She was placed on iron TID, Ferretin daily, and Vit B12 1,000mcg weekly IM. Her Hgb and RBC minutely went up after 6 wks of Vit B12 injections. I think her NSAID is causing the anemia as well as her hiatal hernia problem. She stopped taking Mobic this week to see if her blood levels will improve. What do you think? She was not tested for folate or B12 levels.
Tue, 6 Dec 2016
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General & Family Physician,  's  Response
Hi & Welcome.

Yes, when used for prolonged duration NSAIDs can cause anemia.

Non-selective COX-1/COX-2 inhibitors (nonsteroidal antiinflammatory drugs) like Mobic (Meloxicam) suppress the pain and swelling by reducing the levels of prostaglandins which are actually useful in protecting stomach lining from the harmful effects of stomach acid and its blood supply.

So, a decreased level of prostaglandin can result in gastritis, ulcers of the stomach or duodenum causing bleeding.

The chronic NSAID use may present with iron deficiency anaemia or hypoalbuminaemia due to blood or protein loss, and may develop overt bleeding, perforation, or strictures.

Apart from NSAID induce bleeding, the chronic kidney disease is also responsible for her anemia. Patients suffering from chronic kidney disease do not produce enough hormone erythropoeitin (which is required for the formation of red blood cells in the bone marrow) thus resulting in anemia.

So, in addition to taking iron and multivitamins she may also need injection erythropoetin to increase her hemoglobin level and thus to prevent anemia.

Hope the advice given above would be useful to her.

Best wishes.
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Can NSAID Cause Anemia?

Hi & Welcome. Yes, when used for prolonged duration NSAIDs can cause anemia. Non-selective COX-1/COX-2 inhibitors (nonsteroidal antiinflammatory drugs) like Mobic (Meloxicam) suppress the pain and swelling by reducing the levels of prostaglandins which are actually useful in protecting stomach lining from the harmful effects of stomach acid and its blood supply. So, a decreased level of prostaglandin can result in gastritis, ulcers of the stomach or duodenum causing bleeding. The chronic NSAID use may present with iron deficiency anaemia or hypoalbuminaemia due to blood or protein loss, and may develop overt bleeding, perforation, or strictures. Apart from NSAID induce bleeding, the chronic kidney disease is also responsible for her anemia. Patients suffering from chronic kidney disease do not produce enough hormone erythropoeitin (which is required for the formation of red blood cells in the bone marrow) thus resulting in anemia. So, in addition to taking iron and multivitamins she may also need injection erythropoetin to increase her hemoglobin level and thus to prevent anemia. Hope the advice given above would be useful to her. Best wishes.