Very low iron - gastroscopy?

[skolastica]

Very low iron - the Dr has suggested a blood transfusion as an option - with other tests, such as a gastroscopy to explore possible causes. I'm 49, have had quite heavy periods for a number of years, so hope this is a cause. We've tentatively agreed that I'll start on iron tablets and see how it goes. Apart from low energy, I feel fine. Does anyone know what a gastroscopy is looking for?

Iron deficiency anaemia can be caused by tumours of the digestive system. The majority isn't, of course, but it is quite routine to check with a gastroscopy and colonoscopy just to be sure. It is a balance of risk, so if you are young and have another more likely cause of anaemia, then its not worth the risks of the investigations. If you are older/male, then it would be foolish not to look, as if they are found early then results of treatment are much better.

Please dont be too worried - it is highly unlikely you have anything to worry about, but this is why the GP was thinking about it.

Thanks Wildfire - thought it might be something nasty! My level is 84, with range being 115-165.

I'd say coeliac disease and I'd look to see if your calcium was low in case that gives a clue about that too.

Don't adjust the amount of gluten you're eating now though as it will skew the results.

I had the same symptoms as you, and silent migraines for years. While I had a tough time adjusting to the gf diet even though I already had a good diet, I feel so fantastic now I'm delighted for anyone who gets a positive diagnosis and starts off on the path to feeling better ...

In a way a diagnosis was a bit of a relief

I think the most likely gastrointestinal cause of anaemia would be a gastric bleed. Eg from an ulcer, or use of NSAIDs (ibuprofen etc).

Sorry, not 'use of' but related to long term, heavy use of...

I was going to say same as wildfire.

GI bleeds are acute - in which case a gastroscopy would be done as a matter of urgency. Unlikely in this situation.

Thanks everyone - my calcium is low too - but haven't got all the tests back yet. Coeliac disease isn't on my radar at all(something else to worry about?!) - I thought you had digestive problems with that?

I don't have an ulcer or take ibuprofen more than once or twice a year.

At 49 with an Hb of 84 I would want to have an upper and lower GI endoscopy. They can take samples of the small bowel lining when they do the gastroscopy to check for coeliac disease.

The anaemia may well be due to chronic heavy periods but I would want to exclude other causes before putting it down to this.

BTW are they sure the anaemia is due to iron deficiency

AnnietheAcrobat Thank you for your reply - I just got the bloods today so I'm just dealing with it. I've been given iron tablets on the strength of it, so just beginning treatment/investigation effectively.

The copy of the results says 'suggestive of iron deficiency' and am 84 when the lower normal is 115. Not all the results are back yet. So, I would guess from your reply that you would go for the internal exams? I'm not sure - I feel OK. If the iron tabklets don't raise my levels fast enough, I'll go for the transfusion and maybe get more investigations done at the same time - have to be away from home for at least two overnights for anything beyond the GP surgery, which - unless you want a jolly in town - makes a person think twice about hospital appointments.

Do you have your results printed out? Look for the 'MCV' thats the mean cell volume. If it is lower than it should be, that suggests it could be iron deficiency. If its normal or high, then its likely something else.

I've just had a peek at the NICE guidelines on this and they essentially support the approach that you and your GP are taking.

They say that in menstruating women with no bowel symptoms or family history of bowel/stomach cancer, it is not unreasonable to try treatment first. They also recommend that you have a set of blood tests to screen for coeliac disease.

cks.nice.org.uk/anaemia-iron-deficiency#!scenario

Do keep a close eye on it though. Hopefully you will soon feel a bit brighter.

Thanks Wilfire - yes, MCV is low.

Thanks Anniethe Acrobat - well, feeling like a snail this morning! Have my iron tablets now. My GP practice is very good - I only went for the blood test on Thursday - and I'm sure I'll get fully monitored.

Skolastica, sounds like your doctors are doing a good job of checking out what's wrong.

I just wanted to mention that iron tablets disagree with quite a few people- if you find this to be the case try taking spatone first thing in the morning with Berocca or similar (vitamin c helps you absorb the iron). I did this when really low in iron and unable to tolerate the tablets- it worked very well. but I hope the tablets work ok for you!

It may also turn out to be a bit of a mystery that sorts it's self out with the help of iron tablets.

I was diagnosed with anaemia about 2 years ago. I took the tablets but also had the endoscopy, colonoscopy and bowel X-ray and ultra sounds to check for bleeds and nothing was found. I now have 3 monthly blood tests to check my iron levels are OK.
I also improved my diet, more green leafy veg and meat. I also cut down on tea and coffee because it affects iron absorption.

I hadn't released I was unwell, just thought I was unfit but now feel do much better.
Good luck and try not to worry too much

The iron tablets are brutal. Take them with food and with orange juice or prune juice to aid absorption. Drink lots of water too and very black poo is normal.

Thanks everyone - two iron tablets down. Still in the honeymoon phase... I do have the option of a transfusion - will see how I get on. I've just had to do my BP as my results were reading high in the surgery - and it's stil the same with pulse at 104 when I'm feeling relaxed - used to be a steady 60. I'm assuming it's all related.