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What can cause abdominal pain in ANEMIC persons?

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Hello - I was diagnosed anemic after going to the ER with severe abdominal pains. There has been no definitive diagnosis of what is causing my pain. ( My G I dr. thinks it might be stomach ulcers ) . I just got my tests results from my new CBC this month, my Iron count has gone up from 9 - 15 , normal range on this test starts at 40 . But my hemoglobin, hematocrit and white blood count have gone down. Hemoglobin was already low at 9.1 , now is at 8.8 . Hematocrit was at 29.5, now is at 27.5 . White blood count was at 5.5 normal , now at 3.3 . My G I doctor has been blaming my low blood counts and anemia on heavy periods, but these counts seem very low to me, lower than I have been before. I should start my period in the next few days and I worry with my blood count being so low already when I should worry about my blood count being too low. During my last period I started having cramps in the front of my neck, that stopped happening when the blood loss from my period stopped. I am unsure how to tell when I need to seek emergency care for my low blood count / anemia.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello.

Thank you for your query at DoctorSpring.com.



I understand your concern.

Anemia with a Hemoglobin level of 8.8 will usually not require emergency care even if you start menstruation. However, in case you experience any dizziness, fainting spells, you will have to go to the ER.

I assume you are taking iron supplements for the low iron and in this case, the continuing fall in blood values needs evaluation. In order to help you better, I request you to provide additional details.

- When exactly were you diagnosed with Anemia?

- How long have you had the abdominal pains? If the pain is still persisting, can you please specify the exact site of pain and the type of pain?

- Was an upper GI endoscopy done by your GI doctor since he is suspecting stomach ulcers?

- What treatment were you given for it and did it help?

- How long have you had the heavy periods? Have you been evaluated for this? Any diagnosis/treatment?

- It would be extremely helpful if you could upload reports of your blood work instead of typing them. You can take pictures and upload them in the follow up.

Looking forward to hearing from you.

Take care.



Patient replied :

Unfortunately, when I try and paste my notes for you to see the service says I exceed the text limit and will not let me post the information. This situation has been going on since march 28th of this year. Before March 28th I was very healthy, had not been to a doctor for 15 years before this situation. I went to the ER because of left side pain starting around shoulder and chest , all the way down left side to above my hip. All they could determine at the ER was severe anemia. Since then I started having stabbing pains above belly button related to eating any food, about 45 minutes to two hours after. I have lost 22 pounds. I have what feels like swelling under my left arm pit intermittently, cramps in the front of my throat intermittently. I am having upper gi endoscopy july 2. I had CT of abdomen done last friday. I got the radiology report today and do not understand these sentences from the report. My doctor will not be in his office to talk to me about the report until tomorrow. Besides these sentences the rest of the CT scan was good, no trouble found
This is from a CT scan of Abdomen - With and Without Contrast
Abdomen:
* Lympatics: Scattered subcentimeter mesenteric and para - aortic lymph nodes, nonspecific. No mesenteric inflammation. No free fluid or pneumoperitoneum.
Pelvis:
* Scattered subcentimeter bilateral iliac chain lymph nodes, nonspecific.
Impression:
* Scattered small mesenteric and retroperitoneal lymph nodes, nonspecific. No evidence of acute inflammation.
I have been given 10 mg of amitriptyline nightly and it helps keep the pain from 7 to about a 2
Heavy periods have been suggested by the dr. To me, my period has always been the same, all my life, never these problems before.


Hello.

Thank you for the additional information. In case you cross the maximum text limit on your consult page, you can always email your complete query to [email protected], mentioning your consult ID in the subject line.



The CBC report shows moderate grade anemia and apart from this, the rest of the values are not of concern.

Your symptoms of left sided abdominal pain and now the belly pains in relation to food with a normal CT abdomen, all point towards acid-peptic disease, with/without a stomach ulcer. This is commonly associated with a H. pylori (a bacteria) infection of the stomach. There can be iron deficiency anemia associated with this condition either due to decreased iron absorption or due to occult loss of blood in stools. The good news is, it resolves completely with treatment. Based on the upper GI findings, your doctor will prescribe antacids/anti-ulcer medications and antibiotics if H. pylori is confirmed, for 7-14 days.

Usually a rise in hemoglobin level by 2 g/dL is seen with 3 weeks of oral iron supplementation. Due to the inflammation of your stomach mucosa, iron may not be absorbed very well. This might be the reason why your hemoglobin and other values are not improving quickly. Once that is treated, your anemia will also improve.

As for the transient swelling in your left armpit, if the swelling is pronounced around the time of your periods, its most likely a part of your breast, known as the "axillary tail of Spence" which is normally found in many women.

Regarding your CT Abdomen, scattered subcentimeter lymph nodes are usually not a cause of concern. They could be a normal finding in you.

My suggestions are:

1. Make sure your diet is rich in green leafy vegetables, beef, chicken, sea food like sardines, clams, molluscs etc. Organ meat like beef/chicken liver is a rich source of iron and you should try and include that in your diet. And of course, continue the iron tablets.

2. You should go ahead and get the Upper GI Endoscopy done. A stool test may also be done, to look for occult blood.

3. Appropriate treatment based on the above test results should resolve your symptoms by 2-3 weeks.

4. You can repeat the CBC after 4 weeks to check for improvement in anemia.

I hope that addresses your concerns. Let me know if I can assist you any further.

Thank you.



Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
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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