Dr. Kerr:

While I was there, two CBC's were done as well as other tests. My hematocrit was 37.1 on one and 37.2 on the other.

Before I kept my appointment, I had had more blood test done and this time he told me I would have to see an gastroenterologist who would probably scope me. My hematocrit was at 30.

I am terribly scared, but I guess I have to do it. Thing is, I am taking lots of meds now to prevent another stroke. Aggrenox is one of them and I know that one of the not-so-common side effects is to cause anemia. I read in one drug info site that lab studies of people taking it showed a decline in the hematocrit of .75% and in the hemoglobin and one other thing I can't remember.

It just seems strange that my values were normal in the hospital where I started taking Aggrenox (oh, and plus Toprol, Lotrel, Raniditine, and Vyrotin) and then they were out of range on subsequent tests.

I am a terribly nervous person and deathly afraid of doctors and medical tests. I may not make it through the colonoscopy! I like my doctor, but am wondering why he said nothing for over a year. I truly thought the anemia problem was a lab mistake..

Please give me your thoughts. I would truly appreciate it since I'm a bit confused.

Answer:

Thanks for sending your question - it is one of the best I've seen in awhile, and you did a great job of explaining the situation and how you feel about it. I hope I can help you understand what is going on and alleviate some of your fears.

First, congratulations on coming away from a stroke with no residual damage!  That is no small feat - especially for those of us who certainly don't feel our age.  Your ability to continue to live independently is so precious - I know you want to maintain it.

Your first hematocrit (the percentage of blood that represents oxygen carrying red blood cells) was just barely on the borderline for anemia. 36% of the blood should be red, and yours was 37% - some doctors might call that anemia, but not too often. Different laboratories have different cut-offs for 'normal' and your lab may say that 38% and below is abnormal. Regardless, 37% was not so bad, so don't feel badly that no one got upset about it a year ago. Simple things like recent flow of IV fluids (like you get in the hospital) can dilute the blood to where it looks like anemia, so we don't get too upset with borderline values like you had then.

But it appears the hematocrit dropped over the next year after your stroke - enough that now it's down to 30%. This is an indication that somewhere, somehow you are slowly losing a little bit of blood, causing anemia. With no obvious source of blood loss, looking at your gastrointestinal tract is an excellent plan.  Anemia can also make you feel more tired than usual - less energy, perhaps even a bit depressed. Anemia is no fun.

It's wonderful that your doctor is not just telling you to eat high iron foods, take an iron supplement and see him/her in another year - although those supplements are a good idea. Leaving it at that would be poor medicine, and you deserve better than that. You deserve to know if there is a treatable reason for the slow blood loss and the anemia. Letting you sit for a year was a fair management, since originally the anemia was borderline at best, but it is appropriate to do more investigation after a 7 point drop. Finding the reason now may prevent many doctor visits and medical procedures later. Well worth it.

Your medication does have stated side effects of 'anemia'. That's because if it thins the blood to help prevent strokes, it keeps blood from clotting so quickly. This decrease in clotting may also cause there to be some mild bleeding somewhere else in your body - most likely in the gastrointestinal tract which is susceptible to polyps, small tears and friction damage. The beginnings of a cancer can also cause slow blood leaks. A very small leak may not be noticeable other than by doing a blood test like your doctors did, so it is impressive that someone there is really paying attention!

I completely agree with the suggestion for a colonoscopy. Everyone over the age of 55 should have one of these anyway for screening purposes - we are curing more cases of early-caught colon cancer than ever before just because people are getting this exam that can find problems early - when they are treatable. A colonoscopy is a relatively simple exam, you are given medications that make it very tolerable, and it can certainly save your life in a simple and nonpainful way. The benefits far outweigh the risks. I speak from personal experience on this particular topic.

So, they are appropriately looking for a source of bleeding somewhere in your GI tract. They can often treat this easily - sometimes during the colonoscopy itself - and then you will know that you are no longer at risk for colon cancer. Whatever they find, you will have more knowledge to make informed decisions about your own health care after this exam.

Your case reminds me of my father many years ago - he too was noted to have a mild/borderline anemia, and his physician encouraged a colonoscopy. At the time I thought the doctor was being overly aggressive, but I did support my father in getting that test. Better safe than sorry. Which was good since they did find the very early beginnings of colon cancer, removed it, and my father lived cancer free to the end of his days!  All because of mild anemia....which I have never ignored since that day.

It is good you like your doctor. I completely understand your fear and dread - it makes getting older more difficult, I know. I recommend that you take a trusted friend with you when you go for the colonoscopy - someone who is calm and comforting to you. Just know that this is something you are doing for yourself, even though you don't want to, and that it will be over in a short while. The payoff could save your life.

Let's hope you get a clear answer, that you are able to continue taking the medications that are protecting you, and that you will soon have one less reason to be fearful. I wish you the best of luck, and a successful clean exam.

Sincerely,

Dr. Kerr