Low Hemoglobin and Iron

[pdallariva 57]

This past April I was DX with a bleeding ulcer and my HGB was all the way down to 7.4 and I needed a blood transfusion. My levels of HGB keep going up and down and Iron levels are always low. About 2 weeks ago I tried to receive iv iron infusion however had a bad reaction. I am scheduled for an endoscopy tomorrow but wanted to seek help with questions I have. If I do the scope and no bleeding is found why does my HGB drop down to 8 and back upto 10 again? I cannot understand this! Also if I react to the iron infusions what is the next step? Any suggestions are welcome. One last thing I follow a good diet but don’t eat much however when I do eat there are times I throw up still.

Desperate for answers!!

[James Marusek 5,244]

From your other posts it appears that you had gastric bypass surgery around 16 months ago.

Your blood needs Iron to work efficiently. Otherwise you become anemic. So if you lose blood then you need to replenish the iron. This loss of blood can be caused by many things, such as a severe cut or a bleeding ulcer. Women lose blood during menstruation. Many times, low iron levels can be controlled through iron supplements. Around my 2nd year post-op, my blood work detected my low iron levels. The chemistry of the iron supplement is important. My surgeon directed me to use ferrous sulfate for the best absorption. So I began taking 65mg daily. After a year, my blood work showed I was too high, so they are having me scale back on the iron.

It is important to put a 2 hour separation between the Vitamins that contain iron and those that contain Calcium. So in my case I found that what works best for me is to take the iron supplements just before bedtime.

Several years ago, blood began to appear in my mom's stool. She became anemic and was rushed to the hospital and received a blood transfusion. In her case, the cause was she was bleeding internally due to the fact that she was taking Excedrine as a pain reliever. An Extra Strength Excedrine contains 250 milligrams of aspirin (a blood thinner). [that is around 3 times the recommended low dose rate of 81 mg.] She was popping 3 or 4 a day for over 3 years. We reasoned this was causing her to bleed internally. We completely took her off Excedrine and any products containing aspirin and she healed up within a few months and the condition was corrected.

According to the internet:

Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

Aspirin is a NSAID.

Other NSAIDs are Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen.

[pdallariva 57]

I had a hysterectomy so I no longer have my period.

[Berry78 4,261]

Low hemoglobin (anything under 12) can be due to bleeding, your Iron deficiency, or even Vitamin deficiencies (folate, b-12, and/or vit. C).

Gastrointestinal bleeding usually results in red or black vomit or stools. Small amounts of blood may not be noticeable. Lets hope your ulcer is healed.

Make sure your bloodwork checks for the other Vitamins to clarify that iron is the only issue.

Have you tried oral iron supplements? There are several different types, some don't cause as many GI side effects (nausea and constipation).

If I figure anything else out, I'll pop back in.

[Berry78 4,261]

Ok, found some more info. It's talking about IV irons.

"Large doses of Iron can be given at one time when using iron dextran. Iron sucrose and ferric gluconate require more frequent doses spread over several weeks. Some patients may have an allergic reaction to IV iron, so a test dose may be administered before the first infusion. Allergic reactions are more common with iron dextran and may necessitate switching to a different preparation. Severe side effects other than allergic reactions are rare and include urticaria (hives), pruritus (itching), and muscle and joint pain."

So they'll likely try you on a different IV iron.