Brief Answer:
Need to find/rule out bleeding

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and shall try my level best to help you with the answers you need sir.

Your RBC levels are on the lower side, and in such a scenario a doctor should always consider unnatural causes for a drop in RBC levels. Once these unnatural causes (eg. bleeding ulcers, etc.) have been ruled out we can assume other less harmful causes.

Your doctor is right in scheduling an abdominal ultrasound and may also choose to go about an endoscopy for further confirmation or ruling out of a particular diagnosis. Please co-operate with your doctor sir, as in most cases the cause is a simple one and once treated, the individual can return back to living a healthy and normal lifestyle.

If you do not mind sir, could you also help me with a little information from your end. I have the following questions sir:
-Do you smoke
-Alcohol consumption (history and present)
-Diet (how many meals per day, gap between meals, etc.)
-Exercise
-Stool (consistency, color, blood seen in stool, etc.)
-Recent weight loss

I hope and pray your doctor finds the cause for the drop in RBC and is able to treat it with ease to help you recover at the earliest. Please be kind enough to take sometime out to write back to me with a response to my questions sir.

I wish you lots of luck, and hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.

---

Brief Answer:
Sounds to me like a GIT cause sir

Detailed Answer:
Hello once again sir.

Thank you so much for that information sir, it really helps.

If a recent endoscopy was unremarkable, then the next thing would be to conduct an ultrasound to look for any abnormalities. If at all nothing is found, then a PET scan would benefit sir.

As for your diet sir, I do not think eating once a day is health in anyway and can also easily result in the blood picture as it is currently seen. But we need to rule out all other conditions before assuming this.

Also important to note is the fact that you have been passing stool several times a day. This can be related to various conditions like irritable bowel syndrome, etc.

As for visual blood in the stool, this does not always mean that blood is not present in the stool, it can still be microscopic sir. I would like to ask you if you experience any of the following symptoms, and if you do then please report the same to your doctor:
-Abdominal bloating occasionally or intermittently
-Abdominal pain or cramping
-Flatulence
-Belching
-Diarrhea or constipation
-Mucus in the stool (rare)
any other gastric symptoms

I hope investigations provide us with information about the cause for your symptoms sir. But from the history and information provided, I strongly suspect a gastrointestinal cause sir. Please follow-up with the ultrasound and if required the PET scan.

I hope you find my response helpful sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help you sir.

Best wishes.

---

Brief Answer:
Need more investigations sir, unclear picture now

Detailed Answer:
Hello sir.

A gallbladder (GB) abnormality would be one of the many gastrointestinal conditions that need to be ruled out. So an abdominal and pelvic ultrasound would certainly help sir. This is the best next step.

The pain described by you would be considered the most typical description of pain associated with GERD sir, and so any doctor would consider the pain the be associated with GERD.

Also, the endoscopy conducted was of your upper gastrointestinal tract or lower sir? If it was only of the upper GIT, then the lower GIT should also be examined with the help of a colonoscopy. But for now, the upper GIT endoscopy would be our first choice because of the history of GERD. So, this can be followed up by a lower GIT endoscopy sometime after the ultrasound (if required).

We need to conduct more investigations to find the exact cause of your drop in RBC sir, but in the meantime your doctor can also initiate moderate replacement of blood.

I look forward to more information and results from the investigations to be conducted, please be patient as we need to be sure of the diagnosis in order to accurately treat you.

I wish you lots of luck and would like you to know that I am always here to help, guide and explain anything and everything you need to know sir.

God bless.

---