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Had chronic high RDW. Have small hiatal hernia and severe gastric reflux and stomach pain. Pelvic and Abdominal CT were normal. Cause?

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Hi, my name is XXXXXXX and I have had chronic high RDW for a year. I now have MCH 25.6, MCH 31.7, Hemaglobin 10.5. My doctor said to start taking Iron supplements, but I eat spinach, XXXXXXX steak, split pea soup (I make) lentil soup, etc. almost daily. I have a small hiatal hernia and severe gastric reflux to the thoracic inlet. Stomach pain in the middle of the night sometimes. Endoscopy benign and Colonoscopy benign. Pelvic and Abdominal CT were normal, besides small hiatal hernia. What could be causing my worsening anemia?

Absolute Eosinophils is 8 L

Taking Zegerid 1 pill daily for reflux disease

My Iron, Total is 34 L
% Saturation is 8 L
Ferritin is 5 L
Posted Wed, 26 Jun 2013 in Cancer
Answered by Dr. Indranil Ghosh 51 minutes later
Thanks for your query.

Your blood picture and iron profile is suggestive of iron deficiency anemia. As teh endoscopy, colonoscopy and CT scans are benign, possibility of any cancer causing this has been ruled out. Many women in menstruating age group have iron deficiency and hence no further workup is usually indicated.
Taking a diet XXXXXXX in iron is good but most of the things that you have mentioned are vegetables where the iron is bound to several organic acids and not available for absorption. You need to take th iron supplements that your doc has prescribed. Without that it will be very difficult to boost your hemoglobin.

Hope I have answered your query. I will be available to answer further followup queries, if any.
Above answer was peer-reviewed by
Follow-up: Had chronic high RDW. Have small hiatal hernia and severe gastric reflux and stomach pain. Pelvic and Abdominal CT were normal. Cause? 7 hours later
I haven't menstruated in over 40 days, and it was light. My tubes are tied, so I am not pregnant. All blood work was performed this week. All CT's, endoscopy, colonoscopy were performed one year ago, so I don't know if they're still valuable in this situation. I'm not vegetarian, but I know plenty who are not anemic. I believe my diet is full of iron, and I've never been anemic before. My Hematacrit is also low on one lab performed. Seems like everything on CBC was low except CBC & WBC were normal and RDW was high (RDW is always high.) Is there any need for testing of Leukemia or Multiple Myeloma or Lymphoma?
Answered by Dr. Indranil Ghosh 5 hours later

To answer your queries point-to-point,
1. Menstrual blood loss causes iron deficiency over long period, hence only the last two cycles do not matter. You may have lost quite some iron over the years. This is of course an intelligent guess and can never be proven.
2. Yes, the scans and endoscopies are quite old but with the level of hemoglobin I would not repeat those rightaway but only if iron supplements do not work.
3. Each person is different in body behavior and there are many vegans who are not anemic and many non-vegans who are anemic. But what is known that iron in plant products is very difficult to absorb.
4. Hematocrit is almost same as hemoglobin value, they are directly proportional, so if hemoglobin is low, hematocrit will also be low. High RDW suggests iron deficiency as a cause of anemia.
5. As all the tests are pointing to iron deficiency anemia and if the WBC and platelets are normal, then there is NO need to workup for leukemia, lymphoma or myeloma.

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