Anemia: Common Symptoms and When to Seek Further Medical Advice

Q: Anemia: Common Symptoms and When to Seek Further Medical Advice

Hello： 1. <br>Your symptoms of dizziness, headache, fatigue, and hair loss are indeed likely related to low ferritin levels. <br>2. <br>Coffee can affect the gastrointestinal absorption of iron; however, if consumed separately from meals, its impact is minimal. <br>Since you ment

Medical consultation

Hello, Dr.
Lin.
I consulted you yesterday regarding my anemia values, but I still have some questions I'd like to ask.
Although my hemoglobin has risen to 11.1, I frequently experience dizziness, headaches, and fatigue.
Could this be related to my ferritin level being only 9.5? Additionally, I have been experiencing significant hair loss and an increase in gray hair.
As for why my ferritin levels haven't improved despite receiving intravenous iron, the doctor couldn't determine the cause.
My menstrual flow is very light, so it shouldn't be due to blood loss, and my gastrointestinal examinations have also been normal with no signs of bleeding.
Could my coffee consumption be a factor? However, since I'm receiving iron directly through IV rather than taking oral iron that relies on absorption in the stomach and intestines, this shouldn't affect iron absorption, right?
Another issue that has been troubling me for a long time, which has also not been explained, is that my lips easily turn pale.
It's not an exaggeration; just waving my hand or taking a deep breath can cause my lips to turn white instantly, followed by dizziness, a feeling of pressure in my head, and slight chest tightness.
My heart rate tends to be faster (around 105-153 beats per minute), and sometimes I experience hand tremors and my extremities feel cold easily.
Previously, my doctor checked my thyroid, performed an echocardiogram, and a 24-hour Holter monitor, all of which were normal, but they noted that my heart rate was too fast.
Recently, the symptoms of pale lips and dizziness have worsened.
What could be the underlying cause? Should I seek further evaluation? What tests should I undergo, and which specialist should I see? Thank you for your patience in reading this lengthy message.

Xiao Ru, 30~39 year old female. Ask Date: 2022/04/16

Dr. Lin Zhebin reply Family Medicine

Hello: 1.
Your symptoms of dizziness, headache, fatigue, and hair loss are indeed likely related to low ferritin levels.
2.
Coffee can affect the gastrointestinal absorption of iron; however, if consumed separately from meals, its impact is minimal.
Since you mentioned that your iron supplements are administered via intravenous injection, this should not be related to gastrointestinal absorption issues.
3.
The paleness of your lips and increased heart rate, accompanied by dizziness, head fullness, and chest tightness, may be associated with low ferritin levels (anemia), hormonal disorders (such as thyroid issues), and potential episodes of arrhythmia.
Although you have undergone tests for thyroid and cardiac function, if you did not experience discomfort during the 24-hour Holter monitor test, it may be challenging to identify any intermittent arrhythmias and their specific types.
You mentioned that deep breathing and arm movements can trigger these symptoms, which raises the possibility that these actions may reduce venous return and provoke arrhythmias.
Additionally, if you experience similar discomfort when suddenly sitting up or standing, you should consider the possibility of orthostatic hypotension.
4.
If your recent symptoms of pale lips and dizziness have worsened, I recommend further evaluation regarding your low ferritin levels.
If there are no obvious abnormalities in absorption or loss, other potential causes could include infections, hormonal disorders (which may sometimes accompany menstrual irregularities), autoimmune diseases (such as antibodies that may damage ferritin), and cancer.
For thorough evaluation, you may want to consult a hematologist.
Furthermore, if you are concerned about cardiac issues, a cardiologist would be the more appropriate specialist.

Reply Date: 2022/04/16

More Info

Understanding anemia is crucial, especially when experiencing symptoms such as dizziness, headaches, fatigue, and changes in hair health. Your hemoglobin level of 11.1 g/dL indicates mild anemia, but the persistence of your symptoms suggests that there may be underlying issues that need to be addressed.

Common Symptoms of Anemia
Anemia can manifest through various symptoms, including:
- Fatigue: A common complaint among individuals with anemia due to insufficient oxygen delivery to tissues.

- Dizziness or Lightheadedness: Often occurs when standing up quickly or during physical exertion.

- Headaches: Resulting from reduced oxygenation of the brain.

- Pale Skin or Lips: This can be a visible sign of anemia.

- Cold Extremities: Poor circulation can lead to feelings of coldness in hands and feet.

- Hair Loss: Anemia can contribute to hair thinning or loss, and the presence of white hair may indicate other nutritional deficiencies or stress.

Relationship Between Iron Levels and Symptoms
Your iron levels, particularly your ferritin (iron storage protein) level of 9.5 ng/mL, are indeed concerning. Low ferritin levels can lead to symptoms of iron deficiency anemia, even if hemoglobin levels are not critically low. The fact that intravenous iron therapy has not significantly raised your ferritin levels could suggest several possibilities:
1. Iron Utilization Issues: Your body may not be utilizing the iron effectively, possibly due to chronic inflammation or other underlying conditions.

2. Malabsorption: Even with intravenous iron, if there are issues with iron metabolism or absorption, levels may not rise as expected.

3. Chronic Blood Loss: Although you mentioned that your gastrointestinal checks were normal, it might be worth revisiting this if symptoms persist.

Impact of Caffeine
Caffeine can interfere with iron absorption, particularly non-heme iron found in plant-based foods. However, since you are receiving intravenous iron, this should not directly affect your iron levels. Nonetheless, it is advisable to monitor your caffeine intake, especially around meals.

Symptoms of Pale Lips and Increased Heart Rate
The symptoms of your lips turning pale, along with dizziness, chest tightness, and increased heart rate (tachycardia), could be indicative of several conditions:
- Vasoconstriction: This could be a response to anxiety or stress, leading to reduced blood flow to the extremities.

- Anemia: As previously mentioned, anemia can cause increased heart rate as the body attempts to compensate for reduced oxygen-carrying capacity.

- Autonomic Nervous System Dysregulation: This can lead to symptoms like palpitations and dizziness.

When to Seek Further Medical Advice
Given your ongoing symptoms and the lack of clear diagnosis despite thorough testing, it would be prudent to seek further medical evaluation. Here are some recommendations:
1. Hematology Consultation: A hematologist can provide specialized insight into your anemia and iron metabolism.

2. Cardiology Evaluation: Since you experience tachycardia and chest tightness, a cardiologist might help rule out any cardiac issues.

3. Endocrinology: If thyroid function tests were normal but symptoms persist, further evaluation for other hormonal imbalances may be warranted.

Recommended Tests
- Complete Blood Count (CBC): To monitor hemoglobin and hematocrit levels.

- Iron Studies: Including serum iron, total iron-binding capacity (TIBC), and ferritin.

- Vitamin B12 and Folate Levels: To rule out other forms of anemia.

- Thyroid Function Tests: To ensure thyroid health.

- Electrocardiogram (ECG): To assess heart rhythm and rate.

In summary, while your hemoglobin levels have improved, the persistence of symptoms suggests a need for further investigation. It is essential to work closely with your healthcare providers to explore these symptoms comprehensively. Don't hesitate to advocate for your health and seek additional opinions if necessary.

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