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Anemia with excessive fatigability and possible internal bleeding.

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Hello, I have been struggling with the symptoms below for what is now going on 3 years. My GP has given up at this point, and the specialist I was referred to did an endoscopy and lactose test but nothing beyond that (results of endoscopy were inflammation and ulcers according to that gastroenterologist). symptoms: extreme fatigue/malaise/lethargy inability to recover from exercise (tired for days) hyperactive bowel extreme shooting pains in lower bowel bloating gas/flatulence inconsistent stools mucous in stool bad breath sore throat burning/sensitive eyes ringing in ears teeth grinding severe joint pain/cracking night sweats irritability heavy heart beat/palpitations inability to focus/concentrate/speak brain fog runny nose every morning frequent urination low blood pressure weight loss originally/inability to gain weight now anxiety muscle pain/weakness previous symptoms: bitter taste in mouth dull pain in upper right abdomen coated tongue itchy skin itchy red blotches on hands bloodshot eyes blood test abnormalities (5 similar tests): high lymphocytes (x2) high bilirubin (x1) low hemoglobin (x3) Thanks in advance, and please let me know if I should direct this inquiry to another specialist. Regards, Brandon

Category: Gastroenterologist, Medical

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Category: HIV- AIDS Specialist
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Thanks for you query at Doctor Spring and my apologies for the delay with respect to the reply.

You have a vast array of symptoms and a few conclusive tests that are concerning me. I am concerned that you are bleeding somewhere internally which is causing you a string of symptoms related to anemia, with or without a possible and underlying illness. Here is what I suggest:

1. Get some blood tests done. You could have a bleeding disorder in which your clotting mechanisms are failing to produce clots as needed for the normal stresses on your blood vessels. You should do a complete blood count and a coagulation profile which includes: hb, platelets, bleeding time, clotting times, activated prothromoplastin time, thromboplastin time, platelet aggregation tests, and include tests for vonwillebrand factor. These tests will give you a clear picture of your coagulation capabilities and also test for clotting factor deficiencies if it is you have it.

2. Investigate whether you have illness in your abdomen that is affecting your liver, gall bladder, or pancreas as these could produce some of the gastrointestinal symptoms you have described as well. You may need to do CT/MRI scans of your abdomen to reveal signs of hepatobiliary disease, pancreatic illness or internal bleeding if present. If your liver is involved in particular, some clotting factors (Vitamin K dependent clotting factors) could be disrupted causing you bleeding in your extremities and eyes. Cancer can also cause bleeding and your physician will have to look for signs of tumors or bleeding tumors as well.

3. Your physician was right on in doing an endoscopy as you have an ulcer, and he/she had an opportunity to check for bleeding. If your ulcer starts to bleed you will need to treat it as your condition could become severe otherwise. Keep on the lookout for vomiting blood or bloody stools and alert a physician immediately if symptoms occur. I also recommend doing colonoscopy to check for lower GI bleeding and ulcerative colitis.

4. Lastly, DO NOT take ibuprofen or any other non-steroidal anti-inflammatory drugs as this will increase bleeding and increase the severity of your condition.

If you start to feel dizzy, light headed, severe pain or fever, go to the hospital immediately as you might be experiencing shock, or disseminated intravascular coagulation and you will need immediate treatment.

Please feel free to discuss as follow-up questions. Take care and be well.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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