When to seek help for anemia

September 17, 2008 5:06 AM

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?

posted by Hildegarde to health (18 comments total)

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.
posted by psychostorm at 5:23 AM on September 17

This really sounds like a question for your doctor, not the Internet
posted by meta_eli at 5:24 AM on September 17

emta_eli, I've obviously been to my doctor. He gave me several prescriptions, but I forgot to ask him this question. I'm just tired of being at the doctor's all the time, so I thought I'd try here first. Being cancergirl gets old really fast.
posted by Hildegarde at 5:27 AM on September 17

Lots of doctors are willing to take questions by e-mail these days. Why not give it a try?
posted by Carol Anne at 5:38 AM on September 17

When my father was recently taken to the hospital for other reasons, they discovered that he was severely anemic. His hemoglobin level was 5 also. They gave him several transfusions of whole blood and iron. That hemoglobin level, combined with his iron levels, concerned them a great deal.

I am not a doctor, but if you are severely anemic and start bleeding heavily, you should probably go to the ER, especially if you feel dizzy or lightheaded. I went to the ER recently when I had extremely heavy menstrual bleeding post-surgery (I was going through super-absorbent "overnight" pads every 20 minutes and felt dizzy and lightheaded). My doctor told me to go to the ER if I was going through more than a super-plus tampon or pad per hour, but only if I also felt dizzy.

My specific advice is: call your doctor and ask him this question before your period gets extremely heavy. If he does not call you back before you begin bleeding heavily and you feel lightheaded or like you are going to pass out, go to the ER.
posted by bedhead at 5:43 AM on September 17

Basically, on preview, I'd like to emphasize bedhead's points above. Because I can confirm as a med student that, even in the absence of symptoms, that kind of hemoglobin level (assuming it's being measured in the standard unit of grams per deciliter) would be enough for many doctors to send you to the hospital straightaway, as well as for many hospitals to transfuse you. Because a hemoglobin of 5 is very VERY low.

Now, I don't know your precise situation here, what medications you've been given, what the rest of your lab values were. Anemia can be caused by many things, and those things can overlap. The anemia directly caused by hypothyroidism, for example, is usually quite mild, but it can also contribute to a bleeding disorder where one bleeds more easily than the rest of the population (thus, more blood loss with periods), which superimposes an additional iron-deficiency anemia. Not all these types of anemia are treated with transfusions. Blahblahblah.

The point is, these things are complicated. Based on the one lab value and the fact your period is starting again, I (as a med student) am frankly worried about you. But your doctor knows a myriad of things about you that I do not. So to not put a fine point on it: this is your doctor's job, so talk to him. Now. And I reiterate bedhead's point that you should have a very low threshold for going to the ER as well.
posted by sappidus at 5:49 AM on September 17

Could you call your doctor instead of trekking back to the hospital and see what he says? It's almost as convenient as asking the internet and probably much better advice.
posted by rmless at 6:01 AM on September 17

Calling my doctor now. :)
posted by Hildegarde at 6:04 AM on September 17

When it's you, you know, it doesn't seem as serious somehow... Anyway, my province has a 24 hour nurse on call, so I called, and she did not like my story either and told me to call my doctor. So I called my doctor and got their answering machine, so I left a message.

I started a new birth control pack, thinking that would cut my period short. The nurse didn't like that I did that without advice. Oops.

Frustrated! I've made a zillion doctor's appointments, I was there Monday night, I just wish things were normal again and I didn't have to chase doctors for answers all the time.

Sorry for the inappropriate askmefi question. I wish I were 4 again and there was someone else around entirely responsible for taking care of me. :/
posted by Hildegarde at 6:15 AM on September 17

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.
posted by unexpected at 7:53 AM on September 17

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.
posted by Sidhedevil at 8:30 AM on September 17

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.
posted by radioamy at 8:34 AM on September 17

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.
posted by delfuego at 8:44 AM on September 17 [1 favorite]

I'm glad you called, and I hope this turns out ok!
posted by rmless at 8:47 AM on September 17

No call back yet. Thanks so much, all. I really appreciate your advice.
posted by Hildegarde at 9:28 AM on September 17

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.
posted by jesirose at 11:45 AM on September 17

Any word yet from your doctor?
posted by bilabial at 4:34 PM on September 17

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.
posted by Hildegarde at 4:45 PM on September 17