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Dear Dr. Roach, I am a 73 year old man. My recent blood tests revealed mild anemia. My doctor ordered a second blood test and a cancer screening kit. Anemia was stable and screening was normal, with no detection of microscopic blood. He does not really understand why my blood tests have revealed mild anemia and I expect to repeat the tests every three months. He asked me to monitor my stool for signs of bloody or black diarrhea.
There was no evidence of this or that. I had a colonoscopy a little over three years ago that resulted in the elimination of a polyp and mild inflammation of the colon, attributed to the solution used to clean the colon.
Is there a possible explanation for slight anemia other than finding traces of blood in the stool?
In other words, are bleeding in the intestinal tract the only explanation for my mild anemia?
My doctor is reluctant to request a colonoscopy if there is no sign of bleeding, as it is only three years since the last one.
C. W.
Anemia, in Latin "too little blood", simply means that the blood count is lower than normal depending on the age and condition of the person. In general, there are two major categories of anemia: your body does not produce enough or you lose blood. However, both can exist at the same time.
If you do not make enough blood, it may be because of the lack of nutrients needed to do it. Folic acid, vitamin B-12 and iron are the most common nutrients. Your doctor will normally check this once anemia is confirmed. If so, the treatment is both replacing the nutrient and understanding why you did not have enough to start with. Diet alone is a rare cause. Bone marrow diseases, which are numerous, constitute the other great clbad of under-production anemias. At the age of 73, your doctor should consider this possibility, which often requires a visit to a hematologist and a bone marrow biopsy to be certain.
Losing blood is sometimes obvious, but when it is not, the gastrointestinal tract is by far the main place where it is lost. Colon cancer is the first concern, but it is unlikely (but not impossible) only three years after a normal colonoscopy. Yet, we have been taught in medicine that iron deficiency in a man or woman who has been in the menopause is presumed to be colon cancer until you prove it is not the case. A colonoscopy done three years ago may not be enough to prove that there is no source of blood loss in the colon; it could develop in three years and even the best colonoscopy can sometimes miss small lesions.
I suspect you may be iron deficient. That's why your doctor is so concerned about the loss of your bowels. There are cases where iron deficiency is due to another cause than bleeding (poor absorption due to celiac disease is common), which can be confusing.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can send questions via email to [email protected].
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