Ease my worries please

My husband is about to see a hematologist and googling around has me worried that he's got something serious, like aplastic anemia. I know we'll find out soon enough, but in the meantime, could you please suggest alternative diagnoses that aren't so scary, so I can think positively?

He is 50 years old, fit as an ox (bike commutes daily), eats healthy, has taken a multivitamin and a baby aspirin daily for decades, is on no other meds, and is in otherwise excellent health -- except for chronic, unexplained anemia. He has had the anemia for at least a decade. About 5 years ago, his GP sent him for endoscopy to rule out internal bleeding. Then she put him on a course of B12 injections, that did nothing. However a few months later, his anemia then improved enough that there was no further follow up and he was okay. This year he went back for a routine check up and his anemia is back, and worse than ever. He had another endoscopy and a colonscopy. His GI tract is normal, no gluten intolerance, nothing. His B12 and folate is also normal, and his GP no longer thinks it's related to diet/B12 deficiency. She has referred him to a hematologist. She has run a ton of blood tests, everything is normal, except for his hemoglobin, which is below normal. She is also concerned with his low total blood count. His WBC and platelets are within normal range - but at the very end of low.

Symptoms - he has all the symptoms of anemia you'd expect. Extreme fatigue, weakness, dizziness, fainting spells, sometimes short of breath, pallor, etc. He has a long history of unexplained, massive bruising (like, covering both his thighs, or his mid-torso). This comes and goes and he's never had a blood test or seen his GP during a bruising episode, but he has reported this to his doctor. On and off history of bleeding gums. And this week he admitted to me that his long bones ache.

He showed me his blood tests so I did see the scores, but he then took the paperwork away from me and filed them at work. I have asked for a copy and he won't give me one, because he knows I am prone to worry too much. He tends to worry too, and I know he is much more worried than he is letting on to me.

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18 Answers
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Would be helpful with the exact values of the CBC. And B12, Folate and Ferritin values.

Are liver and kidney function tests okay?

What are his ethnic origins?

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Yeah, I don't have the exact values. All I can tell you, before he took the paper away, is what I said above. I asked him to bring home the results from work, he said he will, but not until after his hematology appointment, because he doesn't want me worrying and obsessing. Which of course I am doing anyway, while he sleeps the weekend away.

His GP ran the tests about 3 times in the past month, but I only saw one of the test results, the last one, and his GI report. My husband just mentioned today that one of the earlier tests showed his WBC was also below normal, but I guess it bounced back up into normal range.

B12, Folate and Ferritin were all normal; I don't remember what the exact numbers were; they were neither low end of normal, nor high end of normal.

Liver and kidney tests all normal. Every other number was within normal range.

He's Scottish/Irish origin.

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Is he diabetic. Does he take any other medication?

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Not diabetic. No other medications. Just the baby aspirin and a multivitamin.

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Does he take aspirin?
Did he test for fecal blood?

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Yes, just a baby aspirin once a day. Yes, they tested for fecal blood; he was fine.

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But even tested, to me it looks like the most potential culprit. Fecal blood tests are not very good and even low doses ASA can result in micro hemorrhage that could potentially lead to this chronic anemia.

His RDW could help in this analysis.

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Awesome. I'd much rather it be something simple and easily fixed, like that.

Thank you!

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UPDATE: The hematologist just called to bump up his appointment. I did not ask why - hopefully just because there was an earlier opening.

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Please, make sure to update here in case of any news.

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I will.

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Update for you: he had his appointment today, the doctor took blood for more tests, and spent a lot of time (over an hour) with him taking a detailed history and doing a thorough physical exam.

Long story short, next steps are 1) MRI; 2) follow-up blood tests in one month; 3) he's to add an OTC B12 tablet to his daily vitamin schedule, just to see if that makes any difference. They did discuss possible BMB but not just yet.

The MRI part is freaking the hubby out. He's worried he has MS, because he has two relatives with it. I suppose anything is possible but from what I'd been googling, an MRI seems like a logical next step, no?

Would MS cause anemia?

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As for ms and anemia, the most common us confusion between pernicious anemia and ms. I may be missing something, but can't really see a clear connection.
I am a family physician in Brazil, we follow strict guidelines for high-costing procedures. I really can't follow the rationale for the MRI, but I could be wrong and missing something of the big picture here.
I understand - if that's the case - that a bone marrow examination could be WAY more cost-efficient now.

But seriously, I am still bugged by that aspirin. :-)

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It's also possible that I'm missing something of the big picture, as I'm getting my information second-hand from my hubby. It's quite possible he has symptoms he has not shared with me, but shared with the doctor.

Apparently he told the doctor he often has a burning sensation on his arms or legs. That it feels like a sunburn. Whereas he'd told me this weekend it was a bone ache - that his limbs hurt from the inside out.

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It's funny how we men are harder to one about symptoms and other health issues, I wish you the best of luck.
If, as results come, I can be of any help, do not hesitate in calling again.

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Did they rule out aplastic anemia?

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Thank you! I really appreciate your time on this.

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No. My understanding is that a bone marrow biopsy is necessary to make that diagnosis. I guess the hematologist didn't think his CBC was severe enough to warrant that at this time, it sounds like he's going to monitor husband's case closely for awhile. I was not there at the appointment but it sounds like the hematologist gave him a thorough screening for possible neurological issues (more thorough than his GP, from what he's described to me), and whatever he saw with that warranted a referral for the MRI.

I am not the doctor here, but it seems to me that MS is more common than Aplastic Anemia... and he has two relatives with MS... then again it could still be an issue with metabolism/nutritional deficiency.

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