Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Iron deficiency anemia can cause a number of problems.
Sommer said, “Iron deficiency anemia happens when the body doesn’t have enough iron to produce healthy red blood cells. Iron is essential for hemoglobin, which is part of the red blood cell that carries oxygen. When iron is low, oxygen delivery drops, and that’s when people usually start to become symptomatic.”
What are the symptoms?
Sommer said, “Fatigue or low energy, shortness of breath, with exertion, dizziness, lightheadedness, headaches, pale skin and heart palpitations. Something important to keep in mind, anemia develops slowly, so people tend to not have symptoms at all, and when they do become symptomatic, it is because your hemoglobin is very low.. It’s microscopic, meaning it’s small and you can’t see it. So it’s a small daily blood loss over time. The first thing that usually will detect it is annual blood work. So if you go to the doctor and they do your labs every year, and then they tell you, oh, look, your hemoglobin and hematocrit is another one is low. They’re going to probably order some additional studies to check your iron levels to see what’s going on. And usually, iron deficiency anemia is often the first clue that something is happening in the GI tract.”
What are some of those things that could be happening and causing this iron deficiency anemia?
Sommer said, “Gastritis. Gastritis is inflammation in your GI tract, and sometimes it can be so inflamed it can cause bleeding. Stomach or duodenal ulcers, they’re ulcerations that occur in your stomach due to acid eroding at your stomach, that’s usually what causes the ulcers, and then they tend to bleed. Esophagitis is just what it is, just like gastritis, it’s inflammation in your esophagus. So chronic inflammation can lead to areas of bleeding, and then chronic use of NSAIDs. So NSAIDs are ibuprofen, aspirin, naproxen, even the prescription drugs, Meloxicam and Celebrex. Long term use of them, they can cause some GI bleeding.”
What do lower GI sources for this include?
Sommer said, “Thee lower GI sources include the colon polyps, colon cancer, diverticulosis, which also remember, if you have diverticulosis, you’re more susceptible to diverticulitis, which is an inflammatory infection in the bowel, and inflammatory bowel disease, such as Crohn’s disease, it’s chronic inflammation in the bowel. The tissue becomes very fragile, and it can bleed. Hemorrhoids are a problem. So interesting enough people will when they have rectal bleeding, they will say, oh, I think I have hemorrhoids, which they are a common cause of bleeding, but we just can’t say, oh, it is probably your hemorrhoids. It needs to be investigated further.”
Sometimes both an upper and lower endoscopy will be required.
Sommer said, “This is what people hate to hear. But yes, sometimes you need both tests, and that comes straight from all the evidence based medicine that we practice. So iron deficiency anemia is confirmed when blood loss is suspected. Doctors often recommend both an upper and a lower because we don’t know where the bleeding is coming from. So when you have the upper endoscopy, if you do have esophagitis or gastritis, and that’s where the bleeding is coming from, that’s what the camera is going to see. It’s going to go down the esophagus, into your stomach, into the first part of the small intestine, and examine those areas to make sure there’s no areas of bleeding. And the same as the colonoscopy, goes up the bottom end and examines the entire colon. Those issues in the upper and lower parts of the body can cause bleeding, and it can come from either end, and sometimes you could be bleeding from both. There are people that have been diagnosed with ulcers and have also had some type of hemorrhagic issue in their colon.”
Pills won’t necessarily fix the problem.
Sommer said, “Iron pills won’t fix the problem if there’s bleeding involved. If there’s no bleeding involved in this iron deficiency anemia, you could take an iron pill. However, if there is a source of bleeding, they need to be taken care of, whether it’s an ulcer or a polyp or inflammation. So the polyps are removed and inflammation and ulcers are usually treated with medication, depending on what is the cause of the inflammation. With qualified anesthesiologist, you go to sleep, you wake up, you have the best sleep for your life. The prep for a colonoscopy is the worst part of the whole thing. It’s usually well tolerated. Most likely it’s diagnostic. But sometimes, if there’s something that could be cauterized, an area of bleeding, it could be done right then and there, and that could solve the problem.”
Once the cause is found, iron levels usually recover.
Sommer said, “It’s pretty common, but don’t ignore it. In adults, if you do have anemia, especially if you’ve never had it before, and you go for your annual blood work, and all of a sudden it comes up that you have some type of anemia, you need to start thinking about what it could be. When was the last time you had a colonoscopy? Or are you having any other symptoms that we mentioned, shortness of breath, fatigue, you need to look into it deeper, so make sure you follow through. If your doctor tells you, hey, you have anemia and I need you to do XYZ, you follow the instructions.”
For more information on how Key West Surgical Group can help, click here: https://www.keywestsurgicalgroup.com/