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Low hemoglobin count, swollen lymph node in back. All medical test normal. Underlying cause?

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Practicing since : 2002
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I think I had whoophing cough in early september. (no lab test was done to confirm it). But I had all 3 stages of cough. In the past 2 months My hemoglobin count is going down 110 to 100 to 96. Ferratin level is going high 1000-1100. I am very week (sleepy) Weight is going down. ultrasound shows few swallen lymph nodes in the lower back. Last week doctor gave 6 tablets of Apo-Prednisone 50mg and the cough is going down (stopped). Generally I am healthy. Weight was 139lb in Sept. In nov it was 135 and now it is 130 lb. I am consulting a general practioner. He is sending me for all types of test (blood in stool, urin etc) and ultrasound..all come up negitive. What is the next step I can take
Posted Sat, 2 Feb 2013 in Blood Disorders
Answered by Dr. Robert Galamaga 1 hour later
Hello and thank you for sending your question.

Your question is a very good one and I will work on providing you with some information and recommendations.

From the information you sent it does not appear that you have iron deficiency. At the same time it is very necessary to rule out possible sources of bleeding.

If you have not had a upper or lower endoscopy performed this is the next most logical step.

With any type of anemia we have to determine if the low blood count is related to blood loss or if the bone marrow is not making enough sales or if there is somewhere in the body where red blood cells are being consumed. As I mentioned endoscopy would be indicated. In addition there are additional blood test that your doctor can request to make sure that your bone marrow is producing red blood cells. This is one thing which I would recommend and includes at least ordering a reticulocyte count. In addition a pathologist can review your red blood cells under the microscope to see if there is any abnormality going on.

After all of this is performed and if there is still no obvious explanation for having a low blood count your doctor might consider referring you to a hematologist. I hematologist would then study the issues and consider a bone marrow biopsy. A bone marrow biopsy helps the physicians take a look at the factory of your blood cells. In your case I do not suspect a primary bone marrow problem but this should be considered if all the other testing is not indicative of some other problem.

Other potential causes include chronic kidney disease. Would your history of diabetes this does put you at risk for developing anemia. Long-standing diabetes can contribute to chronic kidney disease and this needs to also be considered. Lastly if you had some type of viral infection this can sometimes suppress the bone marrow and can cause a temporary anemia. This should also be considered by your doctors.

Thanks again for sending a question. I hope my response has proven to be helpful. If you have additional concerns you would like to discuss I would be happy to review those with you.

Dr. Robert
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