“Extreme fatigue and lab results?”
I presented to the E.D. with stroke-like symptoms in November. Dropping face and confusion along with vision loss. After extensive tests, no stroke or blood clots were found, but I had a hemoglobin level of 6.5, extremely low ferritin, B12, and vitamin D levels. I was sent to an oncologist who sent me to a gastroenterologist for an endoscopy. That visually looks normal, but biopsy showed autoimmune gastritis. But nothing was said about following up with those findings. The oncologist increased my ferritin tabs which did raise my hemoglobin near normal and did raise my iron levels. In my blood work results, my MVP is 11.4, neutrophils are at 65.2%, and Monocytes are at 9.7% along with my B12 being 1800. These numbers have continuously risen in every test since November. Also, my Lymphocytes are at 20.3% and have been on a downward trend since November. I am still extremely fatigued even though my iron levels have gone back to close to normal. Should I be concerned with any of the test results I mentioned above?
Female | 43 years old
Complaint duration: 5 months
Medications: Iron tabs 3xper day
Conditions: Anemia with possible autoimmune gastritis
3 Answers
Hematologist(BloodSpecialist)Hematologist
The lack of blood clots on head CT was because what you had was probably a transient ischemic attack (TIA) So, the blood clot passed in the brain and didn’t got stock forming a hemorrhagic lesion in the brain. The autoimmune gastritis deserves additional investigation. Your MPV of 11.4 appear to be within the normal limits (8.0 to 12). The fatigue is due to your anemia. The normal hemoglobin levels in female is from 12 to 16 g/dL. The complete blood count (CBC) is the most common test used to confirm anemia. It is part of the routine tests done. The complete CBC test the hemoglobin and hematocrit. The hemoglobin is the iron-rich protein part in the red blood cell that carries the oxygen. The hematocrit is a measure how much space the red blood cells take up in your blood. Low level of hemoglobin or hematocrit signify anemia. Blood transfusion is given if your hemoglobin is less than 8 g/d (grams per deciliter). Blood transfusion is given for anemia, major surgical operation, accident resulting in significant loss, cancer patients, severe burns, patient with hereditary disorders such as hemophilia, and others. Thank you.
Several things are going on:
1) you obviously had bleeding in excess of your iron intake which could have been from the intestine or menstruation. This caused iron deficiency and severe anemia. Your stool should have been checked and still should be checked for occult blood to see if indeed you are bleeding from the bowel. Iron three daly is ridiculous and shows poor knowledge. One tablet, three times per week with meat or fish and not with dairy products or vegetables should be more than enough.
2) your lab values are reasonable now and I question if you need to continue iron if you are not further bleeding anywhere.
3) "possible immune gastritis" is disturbing as this is often a prelude to atrophic gastritis and pernicious anemia due to vitamin B12 malabsorption and deficiency. as well as a higher incidence of malignancy, especially lymphoma.
4) Atrophic gastritis is sometimes found in so-called Schmidt's syndrome an auto-immune disease affecting several endocrine organs like the thyroid and adrenal glands, which could certainly cause fatigue. You are the right sex and age for this and perhaps an endocrinologist may be helpful.
1) you obviously had bleeding in excess of your iron intake which could have been from the intestine or menstruation. This caused iron deficiency and severe anemia. Your stool should have been checked and still should be checked for occult blood to see if indeed you are bleeding from the bowel. Iron three daly is ridiculous and shows poor knowledge. One tablet, three times per week with meat or fish and not with dairy products or vegetables should be more than enough.
2) your lab values are reasonable now and I question if you need to continue iron if you are not further bleeding anywhere.
3) "possible immune gastritis" is disturbing as this is often a prelude to atrophic gastritis and pernicious anemia due to vitamin B12 malabsorption and deficiency. as well as a higher incidence of malignancy, especially lymphoma.
4) Atrophic gastritis is sometimes found in so-called Schmidt's syndrome an auto-immune disease affecting several endocrine organs like the thyroid and adrenal glands, which could certainly cause fatigue. You are the right sex and age for this and perhaps an endocrinologist may be helpful.
Yes. You may need to be treated for the autoimmune gastritis. Discuss that with your gastroenterologist and discuss continued fatigue with the oncologist.
Good luck.
RB Thomas, MD
Good luck.
RB Thomas, MD
