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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Anemia, Achy Joints And Headaches

My dad (age:75) has been getting blood transfusions since May (2 units about 1 a month). He is anemic, tired, has achy joints, had headaches, and passed out temporaraily once. He has had an upper & lower GI, bone marrow test, did a stool sample, had a colonoscopy and ct scan and x-rays. He has a hemotologist, MD, cancer specialist and VA doctor stumped. They do not find where he is passing blood, and the bone marrow test was ok. I thought perhaps he had pernicious anemia, but the doctor says his B12 levels were fine. We are all stumped, and dad is very frustrated. Any suggestions?
Thu, 9 Apr 2015
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Pathologist and Microbiologist,  's  Response
Hi considering your dads age, there are few things that can be possible. In the setting of a normal extensive lower gi examination and tests I would suggest you to perform another bone marrow test and iron studies along with transferrin receptor studies to rule out anemia due to dysplasias that is common with ageing people. Myelodysplasia can be often missed by pathologists as it can be very subtle and it needs to be reviewed by multiple pathologists or hematopathologists. Can you ask the bone marrow guys to send the slides to some hematopathology specialized center like md anderson cancer center or memorial sloan kettering cancer center? Also it is important to rule our iron deficiency due to chronic blood loss from middle or upper gi tract as well as to consider anemia of chronic diseases by doing complete iron and storage studies. Do let me know if you have any more questions for me.I hope the advice is helpful
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Suggest Treatment For Anemia, Achy Joints And Headaches

Hi considering your dads age, there are few things that can be possible. In the setting of a normal extensive lower gi examination and tests I would suggest you to perform another bone marrow test and iron studies along with transferrin receptor studies to rule out anemia due to dysplasias that is common with ageing people. Myelodysplasia can be often missed by pathologists as it can be very subtle and it needs to be reviewed by multiple pathologists or hematopathologists. Can you ask the bone marrow guys to send the slides to some hematopathology specialized center like md anderson cancer center or memorial sloan kettering cancer center? Also it is important to rule our iron deficiency due to chronic blood loss from middle or upper gi tract as well as to consider anemia of chronic diseases by doing complete iron and storage studies. Do let me know if you have any more questions for me.I hope the advice is helpful