Chronic Anemia-Like Symptoms Without Anemia: What Could It Be?

Q: Chronic Anemia-Like Symptoms Without Anemia: What Could It Be?

Hello, Miss：<br>You mentioned experiencing dizziness when squatting and standing up, which may indicate insufficient cerebral blood flow due to changes in posture. <br>If the symptoms are more severe, fainting may occur. <br>"Fainting" is defined as a sudden, temporary loss of co

Feeling chronically anemic without actually being anemic?

To summarize the usual symptoms: I experience dizziness after prolonged sitting, after eating, and when standing up from a squatting position.
I also feel dizzy and have headaches when I fall asleep while sitting.
It feels like my mind is unclear and I can't fully awaken.
Standing up and stretching or moving around helps alleviate the symptoms, but I often feel oxygen-deprived and prone to dizziness (a sensation of dimming vision, but not spinning).
Overall, the symptoms feel like anemia, but after finally getting a blood test two weeks ago, my family medicine doctor informed me that my red blood cell count is normal and that I do not have anemia.
They suggested seeing a psychiatrist, but I feel there is an unresolved issue related to my head or blood.

Additional symptoms: Over the past year, I have frequently experienced a loud thumping sound in my head after climbing stairs, but it is not painful.
I have also been diagnosed with migraines, which occur when my neck and shoulders are under prolonged pressure or fatigue, but the dizziness and headaches from prolonged sitting feel different.
I haven't measured my blood pressure in a few months, but I recall it being normal.
The symptoms resembling anemia have been present for at least five years.

yun, 20~29 year old female. Ask Date: 2023/11/06

Dr. Jiang Junyi reply Neurology

Hello, Miss:
You mentioned experiencing dizziness when squatting and standing up, which may indicate insufficient cerebral blood flow due to changes in posture.
If the symptoms are more severe, fainting may occur.
"Fainting" is defined as a sudden, temporary loss of consciousness that typically resolves on its own within a few seconds, rarely lasting more than a few minutes.
It is usually caused by inadequate cerebral blood flow, which can result from abnormal heart regulation, dysautonomia, stroke, or changes in systemic blood pressure due to medications, among other reasons.
The tilt table test is a detailed examination used to diagnose vasovagal syncope caused by autonomic dysregulation.
The principle of the tilt table test is that when the body transitions from a supine to an upright position, approximately one liter of blood is pulled from the thoracic cavity to the peripheral venous system due to gravity.
During this moment, each heartbeat undergoes various changes, and computer analysis can depict the alterations in physiological parameters, allowing for an assessment and diagnosis of fainting.
For dizziness, the first step is to rule out anemia.
Next, it is important to address any fluid deficits that may be causing insufficient cerebral circulation.
Symptoms can be improved by replenishing fluids and electrolytes.
In addition to magnetic resonance imaging (MRI), blood tests can assist in evaluating dizziness and headaches.
Blood tests may include screening for possible comorbidities such as anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.
I recommend consulting a neurologist to discuss further examinations and treatment options.
Thank you for your inquiry, and feel free to reach out for further discussion.
Wishing you good health, safety, and happiness.
Dr.
Jiang, Department of Neurology, Taoyuan Hospital

Reply Date: 2023/11/06

More Info

Chronic anemia-like symptoms without actual anemia can be perplexing and concerning. Your description of symptoms, such as dizziness when sitting for long periods, feeling faint after eating, and experiencing a sense of mental fog, suggests that there may be underlying issues that need to be addressed. While your blood tests indicate normal red blood cell counts and no anemia, it is essential to explore other potential causes for your symptoms.

1. Orthostatic Hypotension: One possible explanation for your dizziness upon standing or after sitting for a long time could be orthostatic hypotension. This condition occurs when blood pressure drops significantly upon standing, leading to dizziness or lightheadedness. It can be exacerbated by dehydration, prolonged bed rest, or certain medications. If you notice that your symptoms worsen when you stand up quickly, it might be worth discussing this with your healthcare provider.

2. Vestibular Disorders: Given your experience of dizziness and the sensation of "blackouts" without spinning, it may be beneficial to consider vestibular disorders. These conditions affect the inner ear and balance system, leading to dizziness and spatial disorientation. A thorough evaluation by an ear, nose, and throat (ENT) specialist or a neurologist may help identify any vestibular issues.

3. Migraine-Related Dizziness: Since you have a history of migraines, it is possible that your symptoms could be related to migraine-associated vertigo or vestibular migraines. These can occur even in the absence of a headache and may present with dizziness, balance issues, and sensitivity to motion. Keeping a headache diary to track the frequency and nature of your migraines could provide valuable information for your healthcare provider.

4. Anxiety and Stress: Chronic stress and anxiety can manifest physically, leading to symptoms such as dizziness, fatigue, and a sense of mental fog. If you are experiencing significant stress or anxiety, it may be worthwhile to explore relaxation techniques, cognitive-behavioral therapy, or other therapeutic options to manage these feelings.

5. Circulatory Issues: Conditions affecting circulation, such as postural orthostatic tachycardia syndrome (POTS), could also be a factor. POTS is characterized by an abnormal increase in heart rate upon standing, which can lead to dizziness and fatigue. A cardiologist or a specialist in autonomic disorders can help evaluate this possibility.

6. Nutritional Deficiencies: Even if your blood tests show normal red blood cell counts, deficiencies in certain vitamins and minerals, such as vitamin B12, folate, or iron, can still lead to symptoms resembling anemia. A comprehensive nutritional assessment may be beneficial to rule out any deficiencies that could be contributing to your symptoms.

7. Chronic Fatigue Syndrome (CFS): If your symptoms have persisted for an extended period and are accompanied by fatigue that is not alleviated by rest, you may want to consider the possibility of chronic fatigue syndrome. CFS is characterized by profound fatigue, sleep disturbances, and cognitive difficulties, and it often requires a multidisciplinary approach for management.

In conclusion, while your blood tests indicate no anemia, the symptoms you describe warrant further investigation. It is crucial to communicate openly with your healthcare provider about your experiences and concerns. They may recommend additional tests, referrals to specialists, or a comprehensive evaluation to identify the underlying cause of your symptoms. Addressing these issues holistically can lead to improved quality of life and symptom management.

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