Concerns About Low Iron and Platelet Levels: Seeking Advice
Hello everyone, I’m a 26-year-old woman dealing with a background of anxiety, asthma, and a condition called idiopathic condylar resorption. My current medications include Fluoxetine, Symbicort, and Melatonin. Lately, I have been feeling quite anxious after my physician referred me to a hematologist due to concerns regarding low iron levels, a reduced platelet count, unexplained bruising, and some other unusual symptoms. Unfortunately, the information provided was sparse, leading to uncertainty and worry on my part. In my latest blood work, my hemoglobin was recorded at 120 g/L, platelets at 145 ×10⁹/L — which is a bit lower than normal — ferritin at a mere 7 µg/L (indicating a significant deficit), phosphate at 0.64 mmol/L, and vitamin D at 28 nmol/L. I’ve been scheduled for an iron infusion shortly, but I’m confused about the implications of the other results. As for my symptoms, there are mornings when I wake up looking quite pale. I’ve also been experiencing severe itchiness in my legs, particularly in the lower legs and thighs. Additionally, I sometimes feel a burning sensation in my thighs during the night, which seems to come and go. Recently, I’ve noticed several unexplained bruises appearing on my thighs. A couple of weeks ago, I had swelling in the right side of my groin; while that has since resolved, I’m uncertain if it’s relevant to my current issues. Furthermore, I have a persistent anal fissure that occasionally causes bleeding. I’m unsure if this is pertinent but I wanted to mention that my second cousin was diagnosed with Chuvash Polycythemia, a rare genetic blood disorder. I don’t have much knowledge about it, but I felt it was important to share. Do any of these symptoms indicate a serious or urgent health concern? I would greatly appreciate any guidance you may have — even if it’s just advice on what inquiries to make with the hematologist or what types of conditions they might be considering. Thank you!
Answers (1)
9/8/2025, 11:10:43 PM
OpenHealth AI
Your concerns about low iron and platelet levels, along with associated symptoms, are certainly understandable, especially given your anxiety and the lack of clear information. Here’s a structured response to help clarify your situation and guide your next steps.
Main Points:
- Low Iron and Platelet Levels: Your results indicate low ferritin (iron stores), normal but slightly low platelet count, and various symptoms that may need further investigation.
- Symptom Monitoring: Recognize that unexplained bruising, itchiness, and burning sensations can indicate underlying issues, but they can also be related to your anxiety or other factors.
Explanation:
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Iron Deficiency: A ferritin level of 7 µg/L is quite low, indicating your body lacks sufficient iron, which is essential for many bodily functions, including red blood cell production. This can lead to symptoms like fatigue, pallor, and potentially exacerbate anxiety.
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Low Platelet Count: Your platelets are slightly below normal (145 ×10⁹/L). While mild reductions often have no serious implications, they warrant further discussion with a hematologist, especially given your bruising.
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Other Symptoms:
- Itchiness and Burning Sensation: These could be side effects of anxiety, reactions to medications, or potentially linked to your blood profile.
- Unexplained Bruises: This should be monitored, as it might relate to your platelet count or other factors.
- Gastrointestinal Symptoms: The anal fissure and past groin swelling should also be discussed, as they could provide additional context to your overall health.
Next Steps:
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Prepare for Your Hematology Appointment:
- List Your Symptoms: Note how frequently you experience itchiness, bruising, and the burning sensation in your thighs. Document any patterns you notice.
- Question Areas to Discuss:
- What could be causing your low ferritin and platelet levels?
- Are there specific conditions they are investigating, particularly related to your family history of Chuvash Polycythemia?
- What is the significance of your phosphate and vitamin D levels in conjunction with your other results?
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Self-Care:
- Dietary Considerations: Focus on iron-rich foods (like leafy greens, red meat, beans) and vitamin C to enhance iron absorption. Consider discussing iron supplements with your provider until your infusion.
- Manage Anxiety: Engaging in relaxation techniques like deep breathing or mindfulness may help alleviate some anxiety surrounding these symptoms and impending appointments.
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Monitor Symptoms: Keep a record of any new symptoms or changes, especially if your bruising worsens or you develop other concerning signs such as persistent swelling, increased bleeding, or significant changes in your energy levels.
Reassurance:
It’s very normal to feel anxious, especially when navigating complex medical information. The hematologist will have insight into your symptoms and test results that can help clarify your situation. Your proactive approach in seeking clarity is essential for your well-being. Let me know if you have further questions or need more specific strategies!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.