Hello.

Thank you for your query at DoctorSpring.com.

I understand your concern.

Anemia with a Hemoglobin level of 8.8 will usually not require emergency care even if you start menstruation. However, in case you experience any dizziness, fainting spells, you will have to go to the ER.

I assume you are taking iron supplements for the low iron and in this case, the continuing fall in blood values needs evaluation. In order to help you better, I request you to provide additional details.

- When exactly were you diagnosed with Anemia?

- How long have you had the abdominal pains? If the pain is still persisting, can you please specify the exact site of pain and the type of pain?

- Was an upper GI endoscopy done by your GI doctor since he is suspecting stomach ulcers?

- What treatment were you given for it and did it help?

- How long have you had the heavy periods? Have you been evaluated for this? Any diagnosis/treatment?

- It would be extremely helpful if you could upload reports of your blood work instead of typing them. You can take pictures and upload them in the follow up.

Looking forward to hearing from you.

Take care.

Hello.

Thank you for the additional information. In case you cross the maximum text limit on your consult page, you can always email your complete query to [email protected], mentioning your consult ID in the subject line.

The CBC report shows moderate grade anemia and apart from this, the rest of the values are not of concern.

Your symptoms of left sided abdominal pain and now the belly pains in relation to food with a normal CT abdomen, all point towards acid-peptic disease, with/without a stomach ulcer. This is commonly associated with a H. pylori (a bacteria) infection of the stomach. There can be iron deficiency anemia associated with this condition either due to decreased iron absorption or due to occult loss of blood in stools. The good news is, it resolves completely with treatment. Based on the upper GI findings, your doctor will prescribe antacids/anti-ulcer medications and antibiotics if H. pylori is confirmed, for 7-14 days.

Usually a rise in hemoglobin level by 2 g/dL is seen with 3 weeks of oral iron supplementation. Due to the inflammation of your stomach mucosa, iron may not be absorbed very well. This might be the reason why your hemoglobin and other values are not improving quickly. Once that is treated, your anemia will also improve.

As for the transient swelling in your left armpit, if the swelling is pronounced around the time of your periods, its most likely a part of your breast, known as the "axillary tail of Spence" which is normally found in many women.

Regarding your CT Abdomen, scattered subcentimeter lymph nodes are usually not a cause of concern. They could be a normal finding in you.

My suggestions are:

1. Make sure your diet is rich in green leafy vegetables, beef, chicken, sea food like sardines, clams, molluscs etc. Organ meat like beef/chicken liver is a rich source of iron and you should try and include that in your diet. And of course, continue the iron tablets.

2. You should go ahead and get the Upper GI Endoscopy done. A stool test may also be done, to look for occult blood.

3. Appropriate treatment based on the above test results should resolve your symptoms by 2-3 weeks.

4. You can repeat the CBC after 4 weeks to check for improvement in anemia.

I hope that addresses your concerns. Let me know if I can assist you any further.

Thank you.