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Undergone subtotal coloctomy. Found fluctuating hemoglobin level. On steroid. Any advice?

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Posted on Tue, 26 Feb 2013
Question: my wife had undergone subtotal coloctomy in January 2012, Her haemoglobin level is flactuating between 7 to 8.4 except in XXXXXXX 2012 once it was 10.6. She was on steroid for about 5 months inaddition to Azoran (100mg), Ferronia XT, Pentasa (globules-3 sachets daily).
Latest hb is 7.7 . Please advise for iprovement of hb level

XXXXXXX
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Answered by Dr. Iven Romic Rommstein (1 hour later)
Hi, XXXXXXX.

Anaemia is a common complication of colectomy (subtotal or total) because after these procedures the length of bowel is not sufficient for normal vitamin and iron absorption. So this is a reason why your wife needs to take Ferronia XT.
Also, one of side-effect of drugs you have mentioned is anaemia.

First, it needs to be be ruled out what type of anaemia is it.
It can not be known having only hemoglobin level information. If you provide me parameters such as Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin(MCHC) and hematocrit then we would find out is it caused by iron deficiency, gastrointestinal bleeding, or it is side-effect of medicines.

Also I recommend to do:
1.Iron blood levels
2. Vitamin B12 blood levels
3. Gastroscopy (stomach disorder can cause anaemia as well)

After all this treatment can be focused on exact cause.

Just to say at the and, this is definitely a decreased hemoglobin level, but you should not be worried because this is chronic (not acute) anaemia and there is no need to treat it intensively. Even lower hemoglobin levels (6-7) are well tolerated and asymptomatic. If it becomes symptomatic (fatigue, paleness and tingling sensation) then Iron therapy and blood transfusions can be performed, but I am sure it will not be necessary. I suggest to check laboratory findings once a month and follow Iron and vitamin XXXXXXX diet.

Hope I have answered your query. If you have any further questions I will be happy to help.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Iven Romic Rommstein (21 hours later)

Dear Dr XXXXXXX Romic,

Thank you so much for your reply. I am attaching the latest Complete blood Picture report for your review & advice. She had also undergone iron therapy (IV) in September & October 2012 but no improvement in hb was seen instead blood iron
level (Serum ferritin) had gone up to 440.

Please advise

Regards,
XXXXXXX
doctor
Answered by Dr. Iven Romic Rommstein (52 minutes later)
Hi again XXXXXXX

Yes, it is clearer now for me. Findings seems constant.
This is actually macrocytic anemia (low RBC and high MCV) which is in most cases caused by low folate and vitamin B12 intake. So you can be sure that iron deficiency isnt reason for it and there is no need to "pump" ferritin level above its normal range.

Ask you doctor about raising your B12 dosage to see if this is gonna improve laboratory findings. I really hope that this will be helpful.

But i need to be honest and tell you that the bad new is that azathioprine(azoran) is a powerful medicine for this disease; but it is also cytotoxic drug which always damage healthy cells, especially blood cells and bone narrow. This explains low WBC white cells count) and anemia.

It is hard for me to tell the stage of ulcerative colitis now(her doctor must evaluate this) and need for azoran treatment. My experience is: If there is no sign of disease after subtotal colectomy then we evaluate cost-benefit of azoran and steroids. This means that dosage of these drugs can be changed if there are serious symptoms of bone narrow damage. I think this damage isn't that serious but it definitely exists. There is no need for i.v. transfusions and iron at this time. If haemoglobin level keeps falling then you should react.

Remember what I've already said: You dont have to "treat laboratory findings", you have to treat blood disorders only if there are clear symptoms.

Hope I have answered your query. If you have any further questions I will be happy to help and if you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health!
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Dr. Iven Romic Rommstein

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Undergone subtotal coloctomy. Found fluctuating hemoglobin level. On steroid. Any advice?

Hi, XXXXXXX.

Anaemia is a common complication of colectomy (subtotal or total) because after these procedures the length of bowel is not sufficient for normal vitamin and iron absorption. So this is a reason why your wife needs to take Ferronia XT.
Also, one of side-effect of drugs you have mentioned is anaemia.

First, it needs to be be ruled out what type of anaemia is it.
It can not be known having only hemoglobin level information. If you provide me parameters such as Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin(MCHC) and hematocrit then we would find out is it caused by iron deficiency, gastrointestinal bleeding, or it is side-effect of medicines.

Also I recommend to do:
1.Iron blood levels
2. Vitamin B12 blood levels
3. Gastroscopy (stomach disorder can cause anaemia as well)

After all this treatment can be focused on exact cause.

Just to say at the and, this is definitely a decreased hemoglobin level, but you should not be worried because this is chronic (not acute) anaemia and there is no need to treat it intensively. Even lower hemoglobin levels (6-7) are well tolerated and asymptomatic. If it becomes symptomatic (fatigue, paleness and tingling sensation) then Iron therapy and blood transfusions can be performed, but I am sure it will not be necessary. I suggest to check laboratory findings once a month and follow Iron and vitamin XXXXXXX diet.

Hope I have answered your query. If you have any further questions I will be happy to help.