OpenHealth Q&A

Severe Iron Deficiency Anemia and Mallory-Weiss Tear: Understanding the Causes of Blood Loss

Currently 32 weeks gestation while dealing with hyperemesis gravidarum. During the first trimester, my hemoglobin (HGB) level was within normal limits at 12.6. For a few months, I experienced episodes of vomiting that included small amounts of bright red blood mixed with bile, nearly every day. Around the 14-week mark, I began an iron supplement due to developing slight cravings associated with pica. My obstetrician indicated that I likely wasn’t anemic based on my recent normal HGB levels, so no further testing was performed at that time. Things began to stabilize around the 24-week point. However, by week 26, my HGB had dropped to 9.6, prompting me to switch from taking iron on alternate days to daily. When I reached 30 weeks, an unexpected incident occurred: I coughed and subsequently vomited large amounts of bright red blood, despite having minimal vomiting prior. Upon contacting my OB, I was directed to the emergency room, where my HGB showed a slight increase to 10.2, and the bleeding had halted, allowing me to return home. Fast forward exactly one week later: my HGB decreased to 9.3, which, while not alarming, revealed that my iron levels were quite low; I suspect I am significantly iron deficient. I'm including those results below for clarity. Could this abrupt decline in HGB be attributed to my pregnancy and iron deficiency? Alternatively, is it possible that I am experiencing unrecognized internal bleeding? If the Mallory-Weiss tear was contributing to my situation, shouldn’t I continue to be vomiting blood? Lately, I've also had a persistent wet cough with a metallic taste, but I haven’t had any more vomiting since the ER visit. Is this rapid decrease in HGB an accurate reflection of my condition, or could it be influenced by blood volume changes or the timing of when the test was conducted? Over the past week, I’ve felt increasingly unwell—my only previous symptom was a mild case of pica, but now I am experiencing an overwhelming sense of fatigue and occasional breathlessness. I genuinely feel as though I could lose consciousness at any moment, which is a sensation I’ve never encountered before. Is this typical for pregnancy, or is there a possibility that I am unknowingly losing blood? Every time I reach out to my OB clinic, I seem to speak to a different practitioner—physician, nurse, or midwife—leading to concerns about whether they fully understand my medical history. I only disclosed the Mallory-Weiss tear when I went to the ER due to substantial blood loss; I had a similar tear in my prior pregnancy, and my OBGYN assured me it was a normal occurrence that would heal on its own. While one midwife is now informed about the tear, it’s not the same healthcare provider who evaluated my most recent complete blood count and iron levels. I’m a 26-year-old female, weighing 130 lbs, currently in my second pregnancy.

Answers (1)

9/10/2025, 7:40:49 AM

OpenHealth AI

Your situation involves several interconnected health concerns during your pregnancy, including severe iron deficiency anemia, a history of vomiting with blood, a Mallory-Weiss tear, and growing fatigue and breathlessness. It’s essential to take these symptoms seriously, especially as they could indicate various underlying issues.

Main Points

• Your declining hemoglobin (HGB) indicates significant iron deficiency anemia, which can lead to fatigue and breathlessness.
• The bright red blood in your vomit, although it has ceased, may be linked to your previous Mallory-Weiss tear.
• Your symptoms warrant immediate attention to ensure both your safety and that of your developing baby.

Explanation

Iron deficiency anemia is common during pregnancy, especially with severe nausea and vomiting like you’re experiencing with hyperemesis gravidarum. This condition can prevent proper nutrient intake and cause blood loss. The abrupt drop in your HGB levels could be reflective of your anemia due to inadequate iron intake or possibly underlying bleeding, but your recent bleeding episodes have stopped.

Given your current symptoms of overwhelming fatigue and breathlessness, along with your history of a Mallory-Weiss tear, it’s crucial to evaluate possible ongoing internal bleeding or complications related to your pregnancy.

Next Steps

1. Immediate Self-Monitoring:

   • Keep a close watch on your symptoms over the next few days. If you experience dizziness, fainting, or worsening breathlessness, seeking urgent medical evaluation is vital.

2. Increase Iron Intake:

   • Continue taking your iron supplements daily as advised by your healthcare provider. Try to incorporate iron-rich foods into your diet, like lean red meats, spinach, lentils, and fortified cereals. Pair these with vitamin C-rich foods (like oranges or bell peppers) to enhance iron absorption.

3. Hydrate:

   • Ensure you’re drinking plenty of fluids to prevent dehydration, especially if you have a history of vomiting.

4. Keep a Detailed Symptom Log:

   • Document your symptoms, including any instances of vomiting, fatigue levels, or new symptoms that arise over the next week. This will help any healthcare provider have a clearer picture when you discuss your situation again.

5. Consistent Communication:

   • Given your concerns about continuity in care, consider asking for a follow-up appointment with your primary obstetrician to discuss your symptoms and the history of your blood loss. It’s helpful to ensure that one provider is closely monitoring your condition.

6. Request Further Testing:

   • Ask about additional blood tests to gauge your iron levels and overall blood health more comprehensively if your symptoms do not improve or worsen.

Taking these steps can help you manage your symptoms and ensure that both you and your baby remain safe and healthy. If your condition changes or you feel more unwell, seeking immediate medical advice is crucial.