OpenHealth Q&A

Struggling with Low Hemoglobin and Mysterious Blood Clots: Seeking Answers

I am a 46-year-old woman residing in Canada, and my medical journey has become increasingly perplexing. For over seven years, I have been on a stable dose of quetiapine for generalized anxiety disorder, as well as taking pantoprazole twice daily to manage severe heartburn linked to a suspected hiatal hernia, alongside occasional iron supplements. Throughout my life, I have been physically active, routinely walking over 10,000 steps a day until I experienced an unfortunate incident in February 2025 when I fell on ice and fractured my fibula. In March 2024, I visited the emergency room due to intense chest pain accompanied by a persistent cough. I was subsequently hospitalized when my hemoglobin dropped to a critical 69. Despite undergoing multiple diagnostic tests—which included a chest X-ray, EKG, and CT scans—no clear source for my chest pain was identified. It was attributed to muscle strain from coughing and further complicated by the suspected hiatal hernia. During my hospital stay, I underwent several iron infusions, all of which unfortunately provoked adverse reactions, in addition to receiving blood transfusions that managed to elevate my hemoglobin levels to the high 70s. The medical team suspected that the hiatal hernia might have stemmed from severe coughing caused by my COVID-19 illness back in April 2020, which left me with ongoing breathlessness, an occasional dry cough, and a new onset of heartburn. Since my hospitalization, routine blood tests have continually indicated low hemoglobin levels—never exceeding 80. Despite following a healthy diet rich in iron and taking Feramax iron supplements sporadically due to gastrointestinal discomfort, my condition remains unchanged. I have also noticed a significant alteration in my menstrual periods since 2021: they've transformed into mostly clear fluid with minimal blood or clots, which I initially attributed to perimenopause, all while maintaining regular cycles. To investigate the possible causes for my ongoing anemia, I have undergone two endoscopies, a colonoscopy, and an esophageal motility test coupled with a 24-hour pH examination, but no bleeding source has been detected. There is a possibility that a minor bleed might exist in an area inaccessible to standard examinations. I typically have regular bowel movements with no signs of blood or black stools, although I tend to experience bright yellow diarrhea, which improves with a fiber-rich diet and yogurt. A colonoscopy revealed only one small polyp, which wasn't tested due to it being misplaced during removal, but otherwise, my results indicated good gastrointestinal health with celiac tests negative. Following my fracture in 2025, I was fitted with a boot for my left leg. Although it has mostly healed, the process has been slow. I remain committed to daily exercise, such as swimming and light walking, and practicing physiotherapy stretches, but I still depend on a cane for increased mobility, particularly on stairs or uneven terrain. This reliance has been challenging, especially since I do not own a vehicle and rely on walking in all weather conditions. Recently, I returned to the ER due to significant swelling in my left leg—the same leg that sustained the fracture. An ultrasound revealed a large blood clot in my thigh, and blood tests indicated my hemoglobin had dropped to 55, leading to my hospitalization for monitoring while high-dose tenzaperin (administered via a subcutaneous injection) was provided to address the clot. Thankfully, there have been no complications so far, and after receiving three units of blood transfusions, my hemoglobin was noted to be at 78. During my latest CT scan, I had a brief consultation with my physician as he was concluding his shift. He informed me that while everything looked generally normal, there were some old clots present in my lungs, likely remnants from the initial leg injury. I recall experiencing bouts of dizziness following my leg fracture and attributed it to my limited movement, combined with fatigue from low hemoglobin levels. I’m left with pressing questions about these clots: Why didn't they lead to a pulmonary embolism, and since they didn't prove fatal, what is their current implication? How might I eliminate them? Is it conceivable that I've been experiencing a minor gastrointestinal bleed for over a year without further symptoms? Moreover, why is my leg fracture taking so long to heal? It feels as though various issues are interlinked, but the connections remain elusive to me. With my primary care physician relocating and no replacement in sight, I’m in need of guidance on which specialist to consult next before my discharge tomorrow—the hematologist, a gastroenterologist, or possibly an internist? I am eager to identify the right professional who can help unravel this complex situation and provide clarity regarding my troubling medical issues.

Answers (1)

8/6/2025, 6:11:17 AM

OpenHealth AI

Your health journey sounds incredibly challenging, and it’s understandable to feel overwhelmed by the complexities of your condition. Let's break down your situation into manageable points and provide some guidance on the next steps.

Key Points:

1. Persistent Low Hemoglobin & Mysterious Blood Clots: Your ongoing low hemoglobin levels and history of blood clots need comprehensive investigation, especially considering your gastrointestinal symptoms.
2. Potential Interlinking Issues: Factors such as the chronic cough, the abdominal issues related to the hiatal hernia, and the effects of your medications may all play a role in your current symptoms.
3. Specialist Consultation: Finding the right specialist to help clarify your situation is crucial, especially with your primary care physician's transition.

Explanation:

Your fluctuating hemoglobin levels (notably dropping to dangerous levels) are concerning, especially with the history of blood clots. While it’s a positive sign that your clots haven't led to a pulmonary embolism, ongoing monitoring and management are necessary to prevent any complications.

The changes in your menstrual cycle and the potential for a subtle gastrointestinal bleed could be interrelated issues contributing to your anemia. It’s also worth noting that the healing process for your leg fracture may be prolonged due to inflammatory responses or reduced mobility, especially with the additional stressors on your body from ongoing low hemoglobin and treatments.

Immediate Next Steps:

1. Consultation Choice: Prioritize seeing a hematologist as your first specialist. They can provide insights into your anemia, hemoglobin levels, and blood clot management. Discuss your recent blood tests, the history of low hemoglobin, and blood clot formation.

2. Explore Gastrointestinal Concerns: If your discussions with the hematologist suggest that further gastrointestinal evaluation is needed, consider a gastroenterologist. Given that you’ve had endoscopies and colonoscopies already, they might look into less common sources of bleeding or absorption issues.

3. Monitoring and Management: Keep a symptom diary that tracks your hemoglobin levels, menstrual changes, gastrointestinal symptoms, and any instances of dizziness or fatigue. This information will be invaluable when consulting specialists.

4. Nutrition and Lifestyle: Continue your iron-rich diet, but consider discussing alternative forms of iron supplementation that might be easier on your gastrointestinal system, perhaps with your hematologist or a dietitian. Ensuring you stay well-hydrated and maintain a balanced diet can help with recovery from your fracture, but be cautious about activities that could lead to further injury.

5. Incorporate Gentle Mobility Enhancements: With the reliance on a cane, consider working with a physiotherapist who specializes in recovery from fractures. They can offer exercises to improve your strength and stability as you continue your rehabilitation.

Your concerns are valid, and you're actively seeking solutions, which is a positive step. If any symptoms worsen or new ones arise, consider reaching out for medical support promptly. Keep advocating for your health, and don’t hesitate to ask questions during your specialist appointments.