anemia - second opinion?

[simple girl]

Hi all,

My father has been very ill over the last few months. He was admitted to the hospital for CHF (congestive heart failure) a few months ago. Came home and has since been diagnosed with anemia and placed on oxygen. He has been taking iron supplements and the doctors say it will take a long time for his iron levels to improve.

The doctors have not been able to identify a cause for the anemia. We are starting to wonder if we should get a second opinion. We certainly understand that many times there aren't answers, but at the same time, we want to be sure we are advocating for our father as best we can. His quality of life has deteriorated significantly as he has no energy to do anything and is short of breath with the slightest exertion.

So, I thought perhaps we should have him see a hematologist. However, it seems all the hematologists I searched for work in cancer centers. Not sure if this is the right type of doc to seek a second opinion from.

Suggestions/insights welcome.

[Rich_in_Tampa]

Simplegirl, a hematologist is not the right thing to do unless leukemia or such is suspected.

Anemia is not a diagnosis, it's a lab abnormality. It won't respond to iron unless he is iron deficient, which can be determined with a simple blood test. Here are some focused questions you might pose to his doctors:

1. What's causing the anemia. Since he was given iron tablets, has a ferritin or other iron test been shown to be abnormally low?

2. If the iron was low, where is the blood being lost? Does he need scoping to look for ulcer, or other digestive blood loss?

3. It is "anemia of chronic disease" (common to have low blood count when the body if fighting other illnesses)? Are his kidneys functioning OK (kidneys produce hormones which stimulate red cell production)?

4. If the white cells and platelets are also abnormal, should he have a bone marrow test?

These are the types of question which hopefully have been addressed. In the situation you described, anemia of chronic disease would be high on the list, but only his doctors have all the information to tell. Bottom line, don't be satisfied with just "anemia." Find out why it's there.

Hope this helps and best wishes for his recovery.

[simple girl]

Rich, thank you soooooooo much. Now I know how to proceed. I really didn't know what the right questions were to ask.

I do remember when he was in the hospital the nurse said something about his kidneys not doing well, so that may very well be the cause. Now, however, we can ask the additional questions to make sure nothing else is going on.

I just really want to thank you again for pointing me in the right direction.

[haha]

Originally Posted by Rich_in_Tampa

Anemia is not a diagnosis, it's a lab abnormality. It won't respond to iron unless he is iron deficient, which can be determined with a simple blood test.

It is shocking that today, 2007, many men or post-menopausal women are sent home from the doctor with a bottle of iron pills for their anemia. Often the "doctor" hasn't even looked at a blood smear, done a stool occult blood, or done anything else that would help the patient in more than a "Well, sometimes it's iron deficiency and we don't always know why".

Hello, if you don't have normal hemoglobin, you are not making enough, it isn't lasting long enough in your body, or you are losing it outside your body. The doc's job is to find out which of these is happening, and why. I went through this crap with my parents, and it left an annoyance that still persists.

I think there is often a huge gap, even today, between tertiary medical center practice and the typical suburban practicing doc.

Maybe we need more, rather than fewer mal-practice plaintiffs attorneys.

Ha

[Rich_in_Tampa]

Originally Posted by simple girl

I just really want to thank you again for pointing me in the right direction.

My pleasure.