Doc: Low iron causes: not enough, losing too much

Keith Roach
To Your Health

Dear Dr. Roach: I am 76 years old. For the past three years, my hemoglobin has been very low. The lowest it has been is 7. I took iron for more than three months, and it made no difference. I have been checked several times for internal bleeding and do not have any. I have rheumatoid arthritis and take azathioprine. I was taken off my medication, thinking that was the problem, and it made no difference. My blood count went up on 5 mg of prednisone, but went back down when it was reduced to 2.5 mg. What do you suggest at this point?


Dear A.N.: I don’t have enough information to give you an answer, and I am worried that your doctor doesn’t either. When I see serious anemia, I break it down by cause: not making enough iron, or losing too much.

Not making enough can come from not taking in enough nutrients (iron, vitamin B-12 and folic acid are the most common), or from something going wrong with the bone marrow (azathioprine commonly does that, but there are many other possible causes). Losing too much can come from bleeding, but also from destruction.

I don’t know why the prednisone is apparently affecting the hemoglobin, but it could be an autoimmune destruction of the blood cells.

I do think you need a re-evaluation or, at the very least, better education on why your blood count is low. If your doctor doesn’t know, you may benefit from an evaluation by a hematologist.

Dear Dr. Roach: I’m a mid-20s woman, not overweight and I’ve never have been. Ever since about age 13, I have had this swishing sound in my stomach. When I push my stomach out, it sounds as if something is filling up with fluid, and when I let my breath out, it gurgles again. It comes and goes whenever, and I’ve never been able to pin it to a specific time of the month or to something I’ve eaten or drunk. I’ve never been to a doctor to check it out, as it is not painful. I checked out hernias on websites, and it doesn’t seem to match anything. Can you help me?


Dear G.O.: This sounds like a succussion splash, which is usually normal. Anyone can try this by drinking a glass of water on an empty stomach, and moving the stomach in and out quickly in a quiet room, and you’ll hear the fluid in the stomach sloshing around, even without a stethoscope (there almost always is a little air in the stomach, as well). If the stomach gets very distended, as in gastroparesis, a condition where the stomach doesn’t empty normally, the succession splash can be abnormally prolonged.

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