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Suggest Treatment For Iron Deficient Anemia
Question: Hi - I was diagnosed with iron deficient anemia in January. I am a endurance athlete running avg 60-80 miles per week. My levels were borderline low - hematocrit 39, hemoglobin 12.7, ferritin 30. I had an endoscopy/colonscopy to rule out bleeding. I also had regular nosebleeds - 3-4x/ week (gp didnt think that was enough - i also just had that cauterized last week. I started iron supplements of 65mg elemental iron per day in January - in April I was retested and my blood improved significantly hematocrit 44, hemoglobin 15. Weirdly my ferritin dropped to 28. GP. Said he thought possibly the iron went straight to improve the blood but hadn't had time to improve my stores. He suggested that I take 2 iron pills of ferrous sulfate 65mg elemental iron per day and that my ferritin should improve - do you agree? Should I see hematologist, how long should it take to get ferritin up? I've read most sports drs recommend endurance athletes to have ferritin > 60? Thx
Brief Answer:
Your Nose Bleed can be a sign of HHT
Detailed Answer:
Hello
I am Dr.Omer and I am here to help you with your query.
You are 43 year old healthy male having low hematocrit, almost normal heamoglobin 12.7 with low ferritin. Here I would describe a condition that I am suspecting in your case.
Hereditary heamorrhagic telangeictasia (HHT) is a disease who presents with recurrent nose bleeds. The nose bleeds are usually severe enough causing low hematocrit and the patient may require iron supplements and in some cases blood transfusion. The nose bleed occurs almost 1/week. The nose bleed starts when you are in 20s. As this disease has many variants i.e some have only nose bleeds while others present with intestinal heamorrhage, low ferritin (iron deficiency anemia and nose bleed after their 40s.
The nose bleed is usually prolonged when occurs and requires cautery or laser therapy. Normal nose bleed in people DONOT require cautery as it stops spontaneously.
The telangeictasia (swollen vessel) are usually so small in stomach and intestine and are usually missed.The swollen vessel can be any where in the abdomen like in liver, stomach, intestine and lung.
Unfortunately there is only genetic testing for this disease that is ALK and SMAD 4 mutations.
Most of the diagnosis of HHT is made clinically.
Your ferritin will be low as mild bleed occurs from nose or other sites of swollen vessel like i told your earlier. You need to take iron tablets 2-3 per days and the ferritin will increase in 6 weeks or so if no other bleed occurs.
You need to see a gastroenterologist not a heamotologist for capsule endoscopy/colonscopy with Contrast enhanced CT of abdomen as it can easily show us swollen vessel in your body with bronchoscopy.
Hope this explains your query in detail.
Feel free to ask any further queries.
Take care.
Your Nose Bleed can be a sign of HHT
Detailed Answer:
Hello
I am Dr.Omer and I am here to help you with your query.
You are 43 year old healthy male having low hematocrit, almost normal heamoglobin 12.7 with low ferritin. Here I would describe a condition that I am suspecting in your case.
Hereditary heamorrhagic telangeictasia (HHT) is a disease who presents with recurrent nose bleeds. The nose bleeds are usually severe enough causing low hematocrit and the patient may require iron supplements and in some cases blood transfusion. The nose bleed occurs almost 1/week. The nose bleed starts when you are in 20s. As this disease has many variants i.e some have only nose bleeds while others present with intestinal heamorrhage, low ferritin (iron deficiency anemia and nose bleed after their 40s.
The nose bleed is usually prolonged when occurs and requires cautery or laser therapy. Normal nose bleed in people DONOT require cautery as it stops spontaneously.
The telangeictasia (swollen vessel) are usually so small in stomach and intestine and are usually missed.The swollen vessel can be any where in the abdomen like in liver, stomach, intestine and lung.
Unfortunately there is only genetic testing for this disease that is ALK and SMAD 4 mutations.
Most of the diagnosis of HHT is made clinically.
Your ferritin will be low as mild bleed occurs from nose or other sites of swollen vessel like i told your earlier. You need to take iron tablets 2-3 per days and the ferritin will increase in 6 weeks or so if no other bleed occurs.
You need to see a gastroenterologist not a heamotologist for capsule endoscopy/colonscopy with Contrast enhanced CT of abdomen as it can easily show us swollen vessel in your body with bronchoscopy.
Hope this explains your query in detail.
Feel free to ask any further queries.
Take care.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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