Anemia: Causes, Symptoms, and Gastrointestinal Concerns

Q: Anemia: Causes, Symptoms, and Gastrointestinal Concerns

Hello： 1. The diagnosis of anemia generally begins with evaluating hemoglobin (Hb) levels. For normal females, a hemoglobin level below 12 g/dL can objectively indicate anemia. Based on your description, your hemoglobin levels should be normal. 2. The decrease

Anemia-related issues

Hello Doctor, my health check report shows that my average red blood cell volume has been continuously decreasing over the past three years, except for the year 2019, while my platelet count has been steadily increasing.
In November of last year, my health check report first indicated the possibility of thalassemia or iron deficiency anemia.
I always thought that many women have anemia due to their menstrual cycle, so I didn't follow up on it.
However, recently I have been experiencing gastrointestinal symptoms similar to irritable bowel syndrome, which has made me worry that I might have anemia due to gastrointestinal bleeding (although I have not noticed any visible blood in my stools or black tarry stools).
I would like to ask the doctor if these values are considered serious.

In 2018, my average red blood cell volume was 82.7 and my platelet count was 350.
In 2019, my average red blood cell volume was 82.0 and my platelet count was 341, with a white blood cell count of 11.5.
In 2020, my average red blood cell volume was 82.1 and my platelet count was 383, with a white blood cell count of 10.8.
In 2021, my average red blood cell volume was 79.8 and my platelet count was 410, with a white blood cell count of 12.6.
All other blood test values are within the normal range without any abnormal results.
Could this possibly be caused by gastrointestinal bleeding? (I have had an upper endoscopy with no abnormalities, but I have not yet had a colonoscopy.) Is thalassemia always genetically inherited? Thank you, Doctor.

YUU, 20~29 year old female. Ask Date: 2022/10/23

Dr. Lin Zhebin reply Family Medicine

Hello: 1.
The diagnosis of anemia generally begins with evaluating hemoglobin (Hb) levels.
For normal females, a hemoglobin level below 12 g/dL can objectively indicate anemia.
Based on your description, your hemoglobin levels should be normal.
2.
The decrease in your mean corpuscular volume (MCV) over the past few years, along with an increase in platelet count, is more indicative of iron deficiency anemia.
In cases of thalassemia, the mean corpuscular volume typically remains low, and red blood cell (RBC) counts may be elevated, usually without an accompanying increase in platelet count.
Thalassemia is generally hereditary.
3.
Given your age, the most common cause of iron deficiency anemia is usually heavy menstrual bleeding, while the likelihood of gastrointestinal bleeding is low.
If you are concerned about gastrointestinal bleeding, a non-invasive fecal occult blood test can be a good initial option.
Of course, endoscopy (gastroscopy and colonoscopy) would provide more direct information.
Additionally, the gastrointestinal symptoms you are worried about are unlikely to present with gastrointestinal bleeding.
4.
In summary, I recommend that you first consult a family medicine physician.
This will allow for further evaluation not only of your anemia but also of your elevated white blood cell count.

Reply Date: 2022/10/23

More Info

Anemia is a condition characterized by a deficiency of red blood cells or hemoglobin in the blood, leading to a reduced capacity of the blood to carry oxygen. The causes of anemia can be diverse, including nutritional deficiencies, chronic diseases, genetic disorders, and gastrointestinal (GI) issues. In your case, the concern about potential gastrointestinal bleeding leading to anemia is valid, especially given your recent symptoms and lab results.

From your health check reports, it appears that your mean corpuscular volume (MCV) has been decreasing over the years, which can indicate microcytic anemia, commonly associated with iron deficiency or thalassemia (Mediterranean anemia). The increase in platelet count could also be a response to inflammation or other underlying conditions. While it is common for women to experience anemia related to menstrual cycles, it is crucial to investigate further, especially since you are experiencing gastrointestinal symptoms that could suggest a more serious underlying issue.

The absence of visible blood in your stool does not rule out gastrointestinal bleeding. Conditions such as peptic ulcers, gastritis, or even malignancies can cause slow, chronic bleeding that may not be apparent. Given that you have already undergone an upper endoscopy (gastroscopy) without any abnormalities, it would be prudent to consider a colonoscopy to evaluate the lower GI tract. This is particularly important if you have symptoms like abdominal pain, changes in bowel habits, or unexplained weight loss.

Regarding your question about whether Mediterranean anemia is hereditary, yes, it is a genetic condition. It is caused by mutations in the genes responsible for hemoglobin production, leading to reduced hemoglobin levels and the production of smaller red blood cells. If you have a family history of this condition, it may be worth discussing genetic counseling or testing with your healthcare provider.

To summarize, your lab results indicate a potential issue with your red blood cell production or iron levels, and your gastrointestinal symptoms warrant further investigation. It is essential to follow up with your healthcare provider to discuss the possibility of a colonoscopy and to evaluate your iron levels and overall nutritional status. Additionally, consider discussing your family history and any other symptoms you may have experienced to provide a comprehensive view of your health.

In the meantime, maintaining a balanced diet rich in iron (such as red meat, leafy greens, and legumes) and vitamin C (to enhance iron absorption) can be beneficial. However, it is crucial to address the underlying cause of your anemia and gastrointestinal symptoms with appropriate medical guidance.

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