When to seek help for anemia
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I'm severely anemic and bleeding. How do I know when it's time to go to the hospital? I was diagnosed with severe anemia on Monday. My hemoglobin blood test result was 5. I probably developed anemia from thyroid cancer treatment 6 months ago, as being hypothyroid tends to cause anemia. That's okay, I can cope with it. I am now taking palafer twice a day. But I just got my period again. It's okay now, but it will get very very heavy and painful soon (which, obviously, has been a serious contributing factor to the worsening of my anemia). I realize that I am now losing iron again. What signs should I watch out for that would indicate that I need more serious attention, and possibly a transfusion? Is there anything else I can do to help me safely turbo-load iron during the next few days to account for the iron I'm losing?
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Answer:
Fellow anaemic here (although not as severe as in your case). I can't answer the first question, but here is a partial solution for your second. Can you get a supplement like Spatone (i.e. iron-rich water)? I've had a lot of problems with iron supplements (absorption/ harsh on the stomach) but this is good on both counts. Take it with some fruit juice (NOT grapefruit, orange preferably). Cut down on tea if you drink it (tannin), and eat and drink foods that assist iron absorption, like those containing plenty of Vitamin C. Good luck.
Hildegarde at Ask.Metafilter.Com Visit the source
Other answers
Hildegard, I'm obviously not your doctor, so take this with that in mind. First, that hemoglobin level, as a few others have said, is very concerning; I'm pretty stunned that your doctor didn't deal with that with more than just giving you oral iron. Your hemoglobin is way lower than what would be expected in anemia from hypothyroidism, which typically has a hemoglobin in the 8 range; similarly, the anemia of hypothyroidism is a very gradual process, and given that you received cancer treatment 6 months ago (and likely had a few blood counts done around that), the appearance of an anemia this profound this quickly is very unlike what one would expect were it purely an issue of your hypothyroidism. Your hemoglobin is low enough that I'd worry about the effort your body has to expend just to keep your end tissues supplied with enough oxygen, a level of effort that could easily lead to cardiac output issues and/or failure. Seriously. (An aside: the natural consequence of finding out a patient has a hemoglobin of 5 is to wonder why, and while iron-deficiency anemia is certainly on the list, there are a lot of other worries -- like occult bleeding into your gut, or bone marrow toxicity from one of the medications you received for your thyroid cancer treatment, or an underlying red blood cell disorder that you never knew you had until you faced the stress of your therapy...) Second, total body iron stores can be measured, and if your doctor didn't do this, he/she really needs to before embarking on an iron-will-fix-this journey. We're talking about simple blood tests -- iron binding capacity, ferritin, iron level, and transferrin -- and that'll not just help your doctors know what they're doing with iron supplementation, it'll help point the way towards any other causes of your anemia. Finally, if this really is an iron issue, it's possible to get your iron supplementation intravenously -- iron dextran can be given IV, and dosed such one infusion totally repletes your body's iron stores (meaning that you won't have to take oral iron at all afterwards, at least until the bloodwork is repeated sometime later to see how you're holding onto the iron). The downside to IV iron is that some patients can have an allergic reaction to it, so that's why it's done in an observation unit, but it really is easy to do. Please let us know what your doctor's office says when they call back, and if you don't hear from them at some point through today, I really, really would think about heading to some sort of urgent care setting and getting this addressed.
delfuego
Just to chime in, a hemoglobin level of 5 is "omg, omg, you need blood transfusions ASAP" level. If you can't reach your doctor before you start bleeding, go to the ER.
unexpected
No word from my doctor at all. I am disappointed. I spoke to a telehealth nurse (everyone in the province has access to them 24/7 for free), and she was pretty freaked out by my story too. I spoke to a pharmacist as well. I think what throws people off is the difference between my story and how I look. I'm not deathly pale and I'm not falling apart. So I must not be too far gone, right? Thanks so much to everyone, I'm just doing my best to keep healthy here. I'll make sure I get someone to keep an eye on me for the next few days. Thank you thank you thank you.
Hildegarde
Any word yet from your doctor?
bilabial
What insurance do you have? Some have nurse-lines where you can call and talk to a nurse for free, 24/7. So if your doctor isn't calling back you can call them and ask for advice. An RN isn't a doctor, but is better than random mefites. No offense to us.
jesirose
No call back yet. Thanks so much, all. I really appreciate your advice.
Hildegarde
I'm glad you called, and I hope this turns out ok!
rmless
Just a thought for down the road...ask your doc if you can switch to extended-cycle birth control (Seasonique is the popular brand name, but I believe you can extend your cycle with any birth control pill that gives a consistent dosage every pill). Fewer periods means less bleeding, which will hopefully decrease blood loss.
radioamy
Sorry for the inappropriate askmefi question. No need to apologize. It's important to get feedback/a reality check when you're navigating the maze of illness. Take care of yourself.
Sidhedevil
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