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What causes anemia inspite of no leukemia, bloating, palpating of spleen, diarrhea, negative colonoscopy and endoscopy?

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Internal Medicine Specialist
Practicing since : 2004
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My daughter is 20. She was originally diagnosed with anemia but there seems to be too many unanswered questions as to what has caused it. It came on all of a sudden in Dec. in XXXXXXX her HGB was 69 she ended up in emergency and had to have a blood transfusion. She went up to 86 a week later back down to 70. Today at 73. Endoscopy negative. Colonoscopy negative. Wbc normal but just very low normal. Ferritin below 5. Platelets normal basophils, leukocytes, monocytes all normal. Neg for h pylori. No std no HIV. She is Anglo Saxon. No hx of blood disorders in the family. She is not vegan. FOBT pos for blood. Waiting on celiac test. Her rbc is low her cell count is elevated. B12 normal. Leukemia has been ruled out. No bloating. No tenderness to palpating of spleen. No diarrhea. Ct and X-ray both negative. Tomorrow she has to start iron Iv and probably do another transfusion. Ultrasound booked for March of pelvis and abdomen. What are we missing?
Posted Sat, 22 Mar 2014 in General Health
Answered by Dr. Enrique Molina 36 minutes later
Brief Answer: more studies needed Detailed Answer: in a young female my first thought would be to investigate gynecological sources of her anemia. If her menses are regular and not heavier than usual, I would still suggest her getting an ultrasound of the pelvis and abdomen. Gastrointestinal causes of anemia are also obvious good considerations, and i see she had a negative endoscopy and colonoscopy. The next step would be a Wireless capsule endoscopy (if available at your gastroenterologist office), as this would examine the small bowel which is not easily accessible via endoscopy and colonoscopy. Celiac disease needs to be ruled out, however with her severity of anemia, i would expect her to have diarrhea (from malabsorption). Crohn's disease (or inflammatory bowel disease) should also be considered, and again a wireless capsule endoscopy would help. If all of the above is unremarkable, i would suggest you taking her to a hematologist (blood doctor), as she may need a "Bone marrow biopsy" to see if there is a problem with her body not producing enough red cells, or if her body is destroying her red cells. Many disease can cause this problem. I see that you stated that Leukemia has been ruled out, but if a bone marrow biopsy has not been done she may need it. The fact that she has FOBT positive for blood makes me think it is something gastrointestinal, however keep in mind that this test is not a 100% accurate, and sometimes test becomes positive from blood coming from hemorrhoids, which usually can't explain the anemia. Hope that helps, let me know if you have any further questions or concerns.
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Follow-up: What causes anemia inspite of no leukemia, bloating, palpating of spleen, diarrhea, negative colonoscopy and endoscopy? 2 days later
A ct enteroscopy has been scheduled for April. However she displays no symptoms at all of Crohn's or IBS no constipation no diarrhea no weight loss. I think it is being done to rule it out Hematologist said no bones trow biopsy right now as none of the other blood work is supporting the need to do this My question is it possible that she could have an ectopic pregnancy that is causing this? I know everyone says she's on the pill but I went back over the blood tests and I'm not seeing that it was checked on blood work. Only on urine which was negative however those are not always accurate. She can still have bleeding during the month. An she said its been light. The IV iron has not made her any better Nd she is still tachycardic. What are we missing?
Answered by Dr. Enrique Molina 1 hour later
Brief Answer: get another urine test Detailed Answer: urine tests nowadays are very good, and the chances of her being pregnant after 1 test is very low, however it wouldn't hurt to re-check, if this is a real possibility. again more studies are needed, and CT enteroscopy is appropriate (although a wireless capsule is better), as well as the abdominal ultrasound. Only after all other testing is normal or negative, is that a hematologist would consider a bone marrow biopsy. Gynecological exam is also necessary if she spots blood in between periods.
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