I just got my bi annual blood work done. I have a Jpouch and was diagnosed w/ Crohn's in September of 2006. I've been doing well on Entocort and Xifaxan and B12 shots. My CBC was low. The nurse just called to give me the results-the doc will call later w/ instructions on what it means and what to do, but my question is: I know women's can sometimes be lower b/c of menstration but I take birth control pills continuously and don't have a period, so it shouldn't be low b/c of that right? Mine was 10.7 and the doc said it should be over 12. This just makes me kind of nervous. I'm not seeing blood. I'm having normal bowel movements and things have been generally good, but these are similiar to the levels I had when I had UC (if that's what I had) before the surgery when I was very sick...Ideas?
Thanks!

Liz

Two things:

You can have blood loss that you cannot see. This is why occult blood tests are done on stool samples. Very tiny amounts of blood loss on a regular basis can take its toll if it is not adequately made up in dietary replacement. Either your intake is inadequate, or you are not absorbing it fully. To absorb iron, you need acid with it. People who take acid reducers or blockers also tend to wind up reducing their iron intake, so that is something to keep in mind. You may need something as simple as a multivitamin with iron.

The other thing is that chronic disease can lead to anemia without any blood loss at all. This is because chronic disease can suppress the bone marrow so you produce fewer red blood cells. They can sort this out by checking your iron levels. If your iron levels are normal, then it is not iron deficiency and it is the chronic disease. In that case, your Crohn's needs to be in better control.

A hemoglobin of 10.7 isn't dangerously low, particularly if you developed it over a long period of time, but it is a sign that something isn't right and further investigation is needed. Normal is around 14. They transfuse at around 7.

Jan

Thanks, Jan! You are a wealth of info!

Shocking LOL but Jan was right on. My Dr said norm is about 14 and blood trans under 7... I float from 11 to 13 and never an issue and there are times when you can be losing blood that you dont see. Just make sure you get checked to see the levels it is at. When i went in I was 6.2 - couldnt feel my legs, no energy and felt like I was floating - And yes, I knew I waited way to long.
Good luck

Hi Liz,

Unfortunately, I don't have any particular words of wisdom for you, but I am very interested in learning what your doctor says about your blood levels.

My daughter has a jpouch, and currently her hemoglobin is 8 and her hematocrit is 22. I am somewhat at a loss of how to take care of this issue.

ConnieDenise

Connie, If her surgeon is not being proactive on this, I'd ask for a referral to a hematologist to properly diagnose and treat her anemia. I don't know what age your daughter is, but everything is different in pediatrics to some degree.

Jan

Jan, I have notified her surgeon, and he wants to do a pouchoscopy, but I don't understand why. Her pouch is functioning just fine---her takedown was just over a year agon, and she has not had any problems.

I am worried that any manipulation of the pouch---even by an experienced surgeon----may have a negative affect on it.

ConnieDenise

The standard protocol for most of us is an annual pouch scope for the first year or two to make sure everything is as it should be and if everything is fine, then less frequent scopes are appropriate. With the significant anemia your daughter has, things are not as they should be. So even if it were not warranted as a routine follow up (it is), it is warranted to investigate the anemia. There are people who have pouchitis without any symptoms.

Jan

Hey, Jan. My doc is out of town till Monday. Is there ANYTHING I can do to make myself feel better in the meantime? I feel just about like I may pass out. I am really really fatigued and just want to lie down, but I can't b/c I have to work! Should I try to take iron or do I need to wait to be sure that's what it is? I just think, okay, if they do more tests (which they mentioned) then it's going to be even longer till I feel better. I am just dragging and my head is hurting. I just feel generally blah.
This is what his nurse said:
Liz, I am looking at the labs. Your blood count is 33.9 and it was 42 last October. The low normal is 37. You should address this with primary care provider. Your B12 is within normal range. Sometimes the anemia is nutritional related to diet or perhaps iron levels. Other blood tests would tell more about actual iron levels. I will show the labwork to Dr S. when he returns Monday.

I don't know why I should address this w /my primary doc when they are the ones who ordered the labs!!!! Maybe she just meant in the meantime, but it's Friday afternoon and no one is in, so I guess I just wait...
Thanks.
Liz

You can take iron, but in three days time, you probably won't have much of an effect. If your symptoms get worse, you will just have to go to the emergency room and they will transfuse if necessary. That is really the only way to get a quick improvement. Since your anemia occurred gradually, it really should not be an emergency. The 33.9 is probably not your blood count, but your hematocrit, which is the percentage of red blood cells in your blood. Your red blood cell count should be around 5 and the hemoglobin should be around 14-16 (this is the amount of the iron carrying protein in the red blood cells).

Basically, in the meantime, don't stand up rapidly. Don't exert yourself. Stay hydrated. Don't you have an after hours clinic to get advice during evenings and weekends? You can at least call and see if it is advised to go ahead and take iron sulfate over the weekend. (It probably wouldn't hurt, but I don't know what other medications you are taking).

Jan

Jan, this is what my doc said.

She has microcytic anemia so should be iron deficient. If she wants a baseline iron study we can do that but is not necessary. Should not interfere with her other meds.

Do you think this sounds right? Is microcytic anemia only a result of iron deficienty? He told me to take 325mg of iron twice a day, I think. Any kind of iron I should opt for? Got ideas about a brand or a type? Ie: slow release, etc.
Thank you!

Liz

Sounds about right. Microcytic just means you have small red blood cells, and this is often due to iron deficiency.

Ferrous sulfate usually comes in 325 mg enteric coated pills. It is cheap and easy. Some people have problems with it. I took it for months without any issue. You can buy a bottle and try it and move on to something else if you have problems.

Jan

Jan, I took the iron supps tonight and it is killllling my stomach. Can you get this in a shot or something else?

Yes, but injections can be painful and can leave a stain. Usually they do IV infusions instead. You can try other oral iron preparations.

Jan

quote:

Jan, I took the iron supps tonight and it is killllling my stomach. Can you get this in a shot or something else?

Did you happen to take the iron on an empty stomach? It can be killer on it. I used to take it with food and noticed nothing.

I took it once an empty stomach and was dry heaving and thought I was gonna pass out!