Mediterranean Anemia: Conflicting Diagnoses and Symptoms

Is it Mediterranean anemia?

Hello Dr.
Yao,
1.
Three years ago, I had an examination at Keelung Hospital, where Dr.
A diagnosed me with thalassemia, but Dr.
B said I did not have it, explaining that thalassemia is not the same as Mediterranean anemia.
I didn't understand, but why do different doctors have different interpretations?
2.
I often experience dizziness (over the past few years), which comes on suddenly, followed by difficulty concentrating and my eyes feeling a bit heavy.
It's not the kind of dizziness where everything is spinning.
Five years ago, I had an episode of abdominal pain that made me feel like I needed to have a bowel movement, and the pain was so intense that I fainted.
After I had the bowel movement, I broke out in a cold sweat and felt better.
Could this be related to my anemia, or is it due to my overweight condition? (155 cm, 70 kg)
I would appreciate your insights.
Thank you!

Yiwèn, 20~29 year old female. Ask Date: 2006/08/30

Dr. Yao Quan reply Internal Medicine

Hello, it is difficult to determine why the diagnoses from the two physicians differ.
Is it possible that the two physicians had access to different information? Thalassemia is caused by abnormalities in hemoglobin.
A hemoglobin electrophoresis test can be used for diagnosis.
Patients with thalassemia typically have smaller red blood cells, which is classified as microcytic anemia.
Clinically, when a physician observes microcytic anemia, they may consider whether it is due to thalassemia or iron deficiency anemia.
Perhaps Dr.
A, based on your routine blood tests, suspected thalassemia.
However, Dr.
B may have performed a hemoglobin electrophoresis test and confirmed that your hemoglobin is normal, leading Dr.
B to inform you that it is not thalassemia.
This is one possibility for the differing diagnoses between the two physicians.
Of course, there are other possibilities as well.
To determine whether you have thalassemia or another type of anemia, please visit Dr.
Chen Peng-sheng in the Family Medicine Department or Dr.
Huang Sheng-yi in the Hematology Department at our hospital.
There are many causes of episodic dizziness, and the information you provided is insufficient for a diagnosis.
It is difficult to ascertain whether it is related to anemia or being overweight.
I recommend that you see Dr.
Chen Jian-zhi in the Otolaryngology Department for further examination and treatment.
Taoyuan General Hospital, Internal Medicine, Dr.
Yao Quan.

Reply Date: 2006/08/30

More Info

Understanding Mediterranean Anemia, also known as Thalassemia, can indeed be complex, especially when faced with conflicting diagnoses from different healthcare providers. Let’s break down your concerns and symptoms to provide clarity.

Conflicting Diagnoses
1. Different Interpretations: The discrepancy between the diagnoses from Dr. A and Dr. B could stem from several factors. Thalassemia is a genetic blood disorder characterized by reduced hemoglobin production, which can lead to anemia. However, the term "Mediterranean Anemia" can sometimes be misused or misunderstood. It is crucial to differentiate between thalassemia and other types of anemia. The diagnosis often relies on specific blood tests, including hemoglobin electrophoresis, complete blood count (CBC), and genetic testing. If the results of these tests were interpreted differently or if the tests were not performed, it could lead to conflicting opinions. It is advisable to seek a hematologist's opinion, as they specialize in blood disorders and can provide a more definitive diagnosis.

Symptoms and Their Relation to Anemia
2. Dizziness and Concentration Issues: The symptoms you describe, such as dizziness, difficulty concentrating, and episodes of fainting, can indeed be associated with anemia. Anemia results in a decreased oxygen-carrying capacity of the blood, which can lead to insufficient oxygen reaching the brain and other vital organs, causing dizziness and cognitive issues. Your history of abdominal pain and subsequent diarrhea, which led to fainting, may also be related to dehydration or a sudden drop in blood pressure, particularly if you were experiencing significant blood loss or fluid loss.

3. Weight Considerations: Your weight (70 kg at 155 cm) indicates that you may be classified as overweight, which can contribute to various health issues, including metabolic syndrome, hypertension, and potentially exacerbating symptoms of anemia. Excess weight can lead to increased strain on the cardiovascular system, which may also manifest as dizziness or fatigue. It’s essential to consider a holistic approach to your health, including weight management, to alleviate some of these symptoms.

Recommendations
- Further Testing: If you have not already, consider requesting a comprehensive evaluation from a hematologist. This should include a complete blood count, reticulocyte count, iron studies, and hemoglobin electrophoresis to clarify your diagnosis and determine the type of anemia you may have.

- Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their duration, and any associated factors (like diet, hydration, or activity level). This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

- Lifestyle Modifications: If you are diagnosed with anemia, dietary changes may be beneficial. Incorporating iron-rich foods (like red meat, leafy greens, and legumes) and vitamin C (which enhances iron absorption) can help. Additionally, maintaining a healthy weight through balanced nutrition and regular physical activity can improve your overall health and potentially alleviate some of your symptoms.

- Follow-Up Care: Regular follow-ups with your healthcare provider are crucial, especially if you experience worsening symptoms or new issues arise. This ensures that any changes in your condition are promptly addressed.

In conclusion, navigating conflicting medical opinions can be challenging, but understanding your symptoms and seeking specialized care can lead to a clearer diagnosis and effective management of your health. Always feel empowered to seek a second opinion or further clarification from your healthcare providers.

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