Can gastrointestinal bleeding cause iron deficiency?

Posted on Wed, 14 Oct 2015 in General Health
Question: Dear Doctor,
My 73 years old mother has recently been diagnosed with iron deficiency (serum iron 8 umol/L (low), Transferrin 37 umol/L (normal), Transferrin Saturation 11% (low), Serum Ferritin 11 ug/L (low)). She hasn’t got anaemia and her full blood count is quite normal. All her recent blood test results are attached along with her previous haematology results (files: Recent_BloodTests_07Sep2015.pdf & Haematology_2011_2014.pdf). Her doctor advised her to take some iron supplement pills (Ferrous Fumarate 310 mg + Folic acid 350 ug) for 3 months.

My mother has been suffering from asthma for more than 25 years and osteoarthritis for more than 15 years. She is osteoporotic and has type 2 diabetes and hypertension controlled by pills. Her entire thyroid gland was removed in 2003 (due to thyroid carcinoma from which she completely cured).

In 2011 we lost my 76 years old father from multiple myeloma. At that time we became concerned about my mother since she had lots of pain. Therefore; she underwent some blood tests and bone scans to exclude myeloma. The tests showed no abnormalities in May 2011. In November 2012, her blood tests accidentally showed a trace of monoclonal or possible oligoclonal IgM with kappa light chains in the early to mid gamma region. The tests were repeated in May 2013 showing the same trace of paraproteins. In July 2013, the same tests were performed by another lab and the results did not show any abnormalities (no paraproteins were detected). Her skeletal survey was normal too. Subsequent tests in October and December 2013 also showed that the paraproteins had gone. Please refer to the attached test results from May 2011 to December 2013 (in the file Paraproteins.pdf).

My mother used to have gastrointestinal discomfort (no pain) as her stomach is very sensitive to the medications she usually takes to fix her hypertension and diabetes. In May 2013, she had some abdominal pain and thus her doctor performed a CT abdomen to find out what was going on. Her CT abdomen (a copy of report is attached in the file: CTAbdomen_May2013.pdf) showed very normal. During the last few months she has been suffering from frequent gastrointestinal discomfort and reflux. She has been taking lots of Omeprazole and antacid solution to relieve her symptoms. Once she started taking the iron supplement pills, her gastrointestinal symptoms have relieved significantly.

1. Given that her full blood count, her calcium level, her CRP, her kidney function and her total serum proteins (albumin and globulin) are all normal, could the underlying cause of iron deficiency be myeloma or similar bone marrow malignancies? If so, then shouldn’t it first affect the full blood count before causing iron deficiency? Which one should come first?
2. Could iron deficiency cause gastrointestinal symptoms?
3. Could the underlying cause of iron deficiency be a gastrointestinal bleeding? Given that her symptoms are going away as she continues taking the iron pills and reducing Omeprazole and antacid, and her CT abdomen just 2 years ago was normal.
4. If there were an internal bleeding, then shouldn’t her blood count (haemoglobin, cell counts, platelets count …) and CRP also be affected? (All came normal).
5. Could the Omeprazole and lots of antacid solution intake be the underlying cause of the iron deficiency? We hope that this possibility is true!

I would sincerely appreciate your advice,
With my kindest regards and best wishes.
Answered by Dr. Shailja Puri 30 minutes later
Brief Answer:
Drugs unlikely to cause iron def, no evidence of myeloma or gammopathy

Detailed Answer:
Thanks for posting your query on HealthcareMagic.
I understand your concern.
1. Myeloma or bone marrow malignancies do not cause iron deficiuency in body. Most common cause of iron deficiency is decreased iron in diet, decreased iron absorption and increased loss of iron. Myeloma or other malignancies usually cause normocytic normochromic anemia.
2. Iron deficiency causes anemia and thus features of anemia like tiredness, fatigue, lack of concentration etc. Severe cases can cause cardiovascular symptoms also like increased heart rate and dyspnea.
3. Gastrointestinal bleed can cause iron deficiency. Starting iron treatment improves iron stores in body and thus obviates iron deficiency. CT scan is not the standard test to rule out GI bleed. If there is a suspicion on GI bleed, it is advisable to order endoscopies.
4. Internal bleeding can reduced iron stores in body and thus cause anemia. Hemoglobin level can go below normal level once stores are depleted. It takes some time for the stores to reduce. CRP ia sn acute phase reactant and it will increase in case of inflammation. If there is any focus of inflammation, CRP level will rise.
5. Long term antacid and omeprazole treatment can lead to vitamin B 12 deficiency. Iron deficiency is not known to occur with antacids and omeprazole.

After reviewing the protein electrophoresis reports, it is evident that there is no evidence of myeloma or any other gammopathy.

If you have any other query, I will be glad to answer.

Thanks and take care
Dr Shailja Puri
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Shailja Puri 24 hours later
Dear Dr. Puri,
Thanks for your advice.
According to the recent blood tests performed on 07 Sep 2015:
1. Is there an indication of GI bleeding in the blood tests? Or the blood tests are not enough to detect such bleeding if it exists? What non-invasive (other than endoscopy) examinations can detect GI bleeding?
2. How long on average it would take to restore normal iron levels by taking iron pills given that she hasn't got anaemia?
Best regards
Answered by Dr. Shailja Puri 4 hours later
Brief Answer:
Stool for occult blood for GI bleed,iron for 3 months to correct deficiency

Detailed Answer:
Hello and welcome again,
The blood test show normal hemoglobin and normal hematocrit so there is no indication of blood loss on blood reports.
You can get occult blood in stool. This test detects presence of blood in stools. It can detect blood in stools due to bleeding in any part of gastrointestinal tract (GIT).
There is deficiency of iron on your iron studies.
Iron supplements for 3 months is required to correct iron deficiency and to replenish the iron stores.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Answered by
Dr. Shailja Puri

Pathologist and Microbiologist

Practicing since :2006

Answered : 7890 Questions


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