Anemia and Follow-Up Appointments in Women's Health

Anemia and follow-up appointment time?

I underwent a pre-employment health examination on January 12 of this year (one day after my menstrual period ended), and the relevant values are as follows: Serum Alanine Aminotransferase (ALT or SGPT): 13, Hemoglobin (Hb): 5.8, White Blood Cell Count (WBC): 5800.
Since my hemoglobin seems to be a bit low, I visited a family medicine clinic on March 13.
After the consultation, the family physician suggested that, given my age, we should first consider the possibility of heavy menstrual bleeding (I estimated about 40ml using a tampon, at most 50ml; I'm not sure if this qualifies as heavy).
The physician referred me to an obstetrician-gynecologist.
The OB-GYN performed an abdominal ultrasound and prescribed pain medication (to be taken when in pain), hemostatic medication (to be taken the day after heavy bleeding), and iron supplements (one after breakfast and one after dinner).
The physician inquired about my menstrual cycle (estimated from April 6 to April 11, with a possible one or two-day variance) and requested that I return for a follow-up on April 17 (the physician confirmed that my menstrual period would have ended by then) and asked me to drink 1000cc of water to fill my bladder for the appointment.
Regarding my personal health history:
1.
I donated blood last year, totaling over 10,000cc.
2.
I was often rejected for blood donation in the past due to low hemoglobin levels.
Five years ago, I tried taking iron supplements for about one or two months, but it didn't seem effective.
I used to visit the blood donation vehicle weekly, but I was rejected each time, so I stopped taking iron supplements (after mentioning the iron supplements to a nurse, she looked concerned, which made me realize that iron supplements are not something to take lightly if not anemic), and I also stopped going to donate blood.
3.
After I started cycling last year, I thought that exercise might help with my hemoglobin levels, so I decided to try donating blood again.
During the four times I went to donate blood, my hemoglobin levels were acceptable.
4.
I usually do not feel dizzy or unwell, but there have been a few instances during exercise when I appeared to be very breathless (I was unaware, but others told me).
Since I have something to attend to on April 17, I would like to inquire if it is possible to reschedule my appointment to either April 13 or April 19.
I apologize for reaching out through e-hospital as I have been unable to get through to the hospital by phone.
I'm not sure if rescheduling would affect the physician's assessment, so I wanted to check with the e-hospital physician.
(To be honest, I am not sure what will happen during my next visit; I only guess that they will collect my urine.)
Additionally, I am concerned that my anemia may not solely be due to heavy menstrual bleeding, and I would like to ask the physician if it would be possible to arrange for a blood test.
However, I am unsure if this would involve any issues with health insurance points...
I do not want to put the physician in a difficult position.
I would also like to know what tests are typically conducted under health insurance coverage to check for anemia.

I realize that some of these questions may not be directly related to obstetrics and gynecology, and if it is inconvenient to answer, that is perfectly fine.
Thank you very much.

Miss Hsu, 20~29 year old female. Ask Date: 2024/03/22

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, you may want to have a gynecologist evaluate your delayed menstruation after April 19.
There are many causes of anemia, and it would be advisable to have the doctor check for any gynecological-related issues.
If it is not a gynecological problem, I recommend consulting a hematologist to determine which tests should be performed to identify the underlying cause.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2024/03/22

More Info

Understanding anemia and follow-up appointments in women's health is crucial, especially for women experiencing heavy menstrual bleeding or other symptoms that may indicate an underlying health issue. Based on your situation, it seems you have been experiencing low hemoglobin levels, which can be a sign of anemia. Anemia in women can often be attributed to several factors, including heavy menstrual bleeding, nutritional deficiencies (like iron, vitamin B12, or folate), or chronic diseases.

Anemia and Its Causes
1. Heavy Menstrual Bleeding: You mentioned estimating your menstrual blood loss to be around 40-50 ml, which can be considered on the higher side, especially if it is consistent. Heavy menstrual bleeding (menorrhagia) can lead to iron deficiency anemia, as the body loses more blood than it can replace.

2. Nutritional Deficiencies: Iron deficiency is the most common cause of anemia in women. It’s essential to ensure adequate intake of iron-rich foods (like red meat, beans, lentils, and leafy greens) and consider iron supplements if dietary intake is insufficient. Vitamin B12 and folate are also crucial for red blood cell production, and deficiencies in these vitamins can contribute to anemia.

3. Chronic Conditions: Conditions such as thyroid disorders, kidney disease, or inflammatory diseases can also lead to anemia. It’s important to rule these out, especially if you have a history of low hemoglobin levels.

Follow-Up Appointments
Regarding your follow-up appointment on April 17, it is generally advisable to keep the scheduled appointment as it allows the physician to monitor your condition effectively. However, if you have a scheduling conflict, contacting your healthcare provider to see if you can reschedule to April 13 or April 19 is a good idea. It’s important to communicate your concerns and the reason for the change, as this can help the provider understand your situation better.

Urine Tests and Blood Tests
During your follow-up, the physician may request a urine test to check for any abnormalities that could be contributing to your symptoms. Additionally, if you are concerned about your anemia, you can certainly ask your doctor about getting blood tests done. Common tests to evaluate anemia include:
- Complete Blood Count (CBC): This test measures various components of your blood, including hemoglobin, hematocrit, and red blood cell count.

- Iron Studies: These tests measure serum iron, ferritin (iron stores), and total iron-binding capacity (TIBC) to assess your iron levels.

- Vitamin B12 and Folate Levels: These tests check for deficiencies that could be causing anemia.

Health Insurance Considerations
In terms of health insurance coverage, most insurance plans cover the necessary tests to diagnose and manage anemia, especially if there is a medical indication for them. It’s best to check with your healthcare provider or insurance company regarding specific coverage details.

Conclusion
In summary, it’s essential to address your anemia proactively, especially given your history of low hemoglobin levels and heavy menstrual bleeding. Keeping your follow-up appointment, discussing your concerns with your physician, and requesting the necessary blood tests will help ensure you receive appropriate care. Remember, managing anemia often involves a combination of dietary changes, supplementation, and monitoring, so staying engaged with your healthcare provider is key to improving your health.

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