OpenHealth Q&A

Seeking Guidance on Understanding My Mother’s Persistent and Severe Anemia

Hello everyone, I am reaching out because I am quite concerned about my mother, who is 42 years old, stands at 5 feet 2 inches tall, and weighs around 55 kilograms. For over a year, she has been battling severe anemia, and despite receiving treatment, her condition seems to be deteriorating. Here’s a brief overview of her situation: **Medical Background:** - **Age:** 42 - **Gender:** Female - **Height:** 5’2” - **Weight:** Approximately 55 kg (Her weight fluctuates — she tends to lose pounds when her hemoglobin levels fall, but gains some back following transfusions; overall, she appears slimmer than she did previously). Prior to this, she did not experience any digestive issues such as pain or gas. Her problems commenced in March 2024 when she was diagnosed with anemia, and by April 2025, she began to experience stomach pain. **Hospital Admissions & Investigations:** - **March 2024:** First hospitalization with hemoglobin levels around 4.0, leading to blood transfusions and iron supplements. - **Endoscopy:** Resulted in a diagnosis of pan-erosive gastritis. - After about 4 to 6 months, her hemoglobin levels dropped again, necessitating additional transfusions and iron therapy. - Stool tests for occult blood returned negative on two occasions. - Although a colonoscopy and bone marrow biopsy were recommended, these were postponed due to financial constraints. **Gastrointestinal Evaluation (Later in 2025):** - **Repeat Endoscopy & Colonoscopy:** - Endoscopy revealed pan-erosive gastritis compounded by H. pylori infection, for which she received antibiotic treatment. During this period, she experienced bright red stools. - Colonoscopy identified caecal aphthoid ulcers with active bleeding. - CT enterography indicated asymmetrical thickening of the bowel wall accompanied by mural edema. The biopsy ruled out tuberculosis, but there remains a suggestion that Crohn’s disease or inflammatory bowel disease should not be dismissed. **Current Treatment Protocol:** She has been prescribed mesalamine, budesonide, and esomeprazole. Approximately ten days into this regimen, her dark or tarry stools showed improvement. However, just one and a half months later, her hemoglobin plummeted to 4.3 again. After receiving four blood transfusions, her hemoglobin was elevated to 9.8, but it fell to 5.9 again within just 25 days. **Additional Symptoms:** - Persistent stomach pain, primarily noticeable at night (began in April 2025). - Swelling on the right side of the abdomen that resembles a small lump, which eventually recedes after several hours. - Occasional discomfort in the lower abdomen. - Stool color has been dark green or black for over a year, occasionally lighter but never fully normal. - Liver and kidney function tests have shown normal results with only minor fluctuations. - Results from hematology indicate microcytic hypochromic anemia, with stable white blood cell and platelet counts. - Negative tests for hepatitis and HIV. **Observations:** Her anemia tends to recur and does not improve with iron supplements or transfusions. Now, her hemoglobin levels are declining much more rapidly than before; previously, it would take 3 to 4 months for a drop, but now it occurs in just 20 to 25 days. --- 🔍 Has anyone had experience with anemia linked to Crohn’s or inflammatory bowel disease? 🔍 Should we advocate for a bone marrow biopsy, capsule endoscopy, or other forms of testing? 🔍 Is it possible that there’s an underlying issue outside the gastrointestinal system, despite her normal white blood cell and platelet counts? We are feeling quite helpless and anxious because her anemia just won’t stabilize. Any insights, similar experiences, or recommendations on what we should discuss with her doctors moving forward would be greatly appreciated. Thank you!

Answers (1)

9/14/2025, 5:20:51 PM

OpenHealth AI

I'm really sorry to hear about your mother's persistent struggles with severe anemia. Her situation is clearly complex and concerning, especially considering the associated gastrointestinal issues and rapid drop in hemoglobin levels. Here’s a summary of the main points, along with some thoughts on potential next steps.

Summary of Main Points:

1. Your mother has severe anemia that is recurrent and seems resistant to typical treatments.
2. Investigations have identified potential gastrointestinal issues, including pan-erosive gastritis and possible Crohn’s disease.
3. Symptoms such as stomach pain, changes in stool color, and swelling require close monitoring.

Explanation:

Severe anemia, especially that which rapidly recurs, can stem from several factors, many of which you've already explored. Given her history of gastrointestinal issues, it is likely that malabsorption or ongoing bleeding could be contributing to her anemia. Crohn’s disease and other inflammatory bowel conditions can impair nutrient absorption and lead to chronic blood loss, which may explain her persistent anemia even with treatment.

Your mother's recent symptoms, including the dark stools and abdominal swelling, suggest she may be experiencing significant inflammation or complications within her gastrointestinal tract that need further evaluation. While her blood tests show normal white blood cells and platelets, it is indeed possible she has an ongoing process that has not yet been identified.

Recommended Next Steps:

1. Advocate for Further Gastrointestinal Evaluation: Since your mother has a history suggestive of Crohn’s or inflammatory bowel disease, a capsule endoscopy might help visualize areas of the small intestine that conventional scopes cannot reach and identify any sources of bleeding or inflammation.

2. Consider a Bone Marrow Biopsy: While her blood counts are stable, if her anemia continues to be unresponsive to treatment, a bone marrow biopsy can help rule out marrow problems or abnormalities in red blood cell production.

3. Monitor for Signs of Complications: Keep an eye on symptoms like continued dark or tarry stools, increased abdominal pain, or new symptoms. If these occur, they may indicate a need for more immediate interventions.

4. Discuss with Her Healthcare Team: Share your concerns explicitly with her doctors regarding the rapid decline in hemoglobin levels. Ask if there are any additional tests or referrals to rheumatology or hematology specialists who could offer insights into underlying issues that may not be solely gastrointestinal.

5. Nutrition Assessment: Since she has experienced significant weight changes and malabsorption, working with a dietitian familiar with inflammatory bowel disease may help optimize her nutrition.

6. Emotional Support: Understandably, this situation can be very stressful for both you and your mother. Seeking support groups or counseling might help in managing the emotional toll of chronic health challenges.

Your concerns are valid, and it's important to continue advocating for thorough evaluation and treatment options. Please feel free to reach out for more specific guidance as you navigate this complex situation. Wishing you and your mother strength during this challenging time.