Expert: Claes-Gustaf Nordquist, M.D. - 11/6/2009

Question
QUESTION: Dear Doctor,

I am paul writing from the republic of malta.....I would appreciate if you could kindly help me.....as I was not feel well and suffering from frequent black outs and puffing when I try to walk quickly, go up the stairs etc etc....I went to my GP who examined me and told me that I have hypotension when I usually suffer from hypertension......so he removed all my anti hypertension pills.....however I was not satisfied and insisted that we perform some blood tests.....it was here that it resulted that I was anaemic and had a raised ESR standing at 37......he sent me to a consultant of his choice......this gentlemen again order that I have a blood picture test which confirmed that I am anaemic.....but his other tests that is CRP, fob.s and thaelessimia all resulted in range or negative.  Notwithstanding these results which somewhat reassured me he ordered that I do a colonoscopy and gastroscopy.  Do you agree with him? Could I be suffering from some sort of cancer that i cannot feel?.....all additional information is greatly appreciated.

sincerely hoping to hear from you soon I thank you in advance.




Paul Fava
Malta

ANSWER: Based on what you have written I can only conclude that he has found that you have an iron deficiency anemia. Since you are a male that is disturbing. In menstruating women that is for natural reasons rather common but it is a warning sign in a male. If he also has found blood in your stools indicating that you are bleeding from somewhere in your gastrointestinal tract and that that may cause your iron deficiency anemia then it is understandable that both a gastroscopy and a colonoscopy were ordered in order to find out the cause of bleeding and its location. So in that case I do agree fully! Yes it is possible that the cause of bleeding is a cancer but there are also other possibilities like for example a bleeding ulcer. Good luck!


---------- FOLLOW-UP ----------

QUESTION: Dear Doctor,

I blame myself for not describing all the facts in detail....hence I have further questions if you have the kind patience that is.....well to-date all my stool tests proved negative that is no blood has ever been found in my stools.....and furthermore I do not think that I have an iron defficiency as my 'ferritin' test was in range......hence I can never understand how I am losing blood and it is not being detected......could my body be reabsorbing it somehow?......and if both the colonoscopy and gastroscopy find nothing at fault does that leave me suddenly anaemic without knowing how?.....kindly try to answer to my sincere questions as I am very worried......if I had your e-mail address I would have sent you my full blood results if you accept.

hence sincerely hoping to hear from you soon I thank you in advance...and my your God bless you.

regards.





Paul

Answer
SURE! Please let me have ALL the results of your blood tests so that we can see what kind of anemia you may have. To evaluate an anemia you need A LOT of lab. results. Not just your Hb and ferritin! You need Hb (hemoglobine), hematocrite, red blood cells, thrombocytes, white blood cells, differential counts of the white blood cells, red blood cell indexes (to evaluate size, hemoglobine & hemoglobine concentrations of red blood cells), serum iron etc. etc. It may also be necessary to take biopsies of your bone marrow where the blood is produced. There may be necessary to check not only how fast blood is produced but also how fast it is broken down etc. So a vast number of tests are necessary. You can copy all results here.