I Have Excessive Fatigue, Sleepiness Though I Sleep 8 Hours

Posted on Thu, 10 Apr 2025

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 10 Apr 2025 Answered on

Fri, 9 May 2025 Last reviewed on

Question : From 12-13th March I have excessive fatigue, sleepiness though I sleep 8 hours, yawning and tiredness, nausea and pain in upper back spine especially after sleep causing weakness in all 4 limbs. I underwent various repeatative blood tests. CBC, CRP, LDH, IRON, PBS etc. I was told I have mild anisocytosis and my IRON level dipped from 107 in January to 61 on 7th April. I was told I have Iron deficiency Anemia. On 7th April my Hgb is 13.3. I took iron injection on 7th itself, the very next day on 8th April I underwent CBC twice my hgb went down to 12.2 and then 11.7 in just 24 hours. I undewent GI tract endoscopy and colonoscopy yesterday in hospital only they come normal. My stool and urine also come normal. My CBC and PBS were again repeated this time in hospital. Here my Hgb comes 12.4 ( different lab from which I usually undergo tests) and PBS is also repeated (My latest PBS says normochromic anaemia and rouleaux formation) Im scared whether is this myeloma like I have had PBS 6-7 times last month and it was never mentioned Before that from February I suffered from chronic headaches for a month for which I took NSAIDs which did not relieve my symptoms completely so I underwent CT Brain which came clear last month ( I had previously suffered from migraine headaches and had MRI brain in April 2024) I also had fondue examination of my eyes which was also normal. After 1 month of chronic headaches they subsided

Answered by Dr. Diwashish Biswas (17 hours later)

Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,

Your symptoms of fatigue, weakness, and fluctuating hemoglobin along with low iron suggest iron deficiency anemia, which is a common and treatable cause of your complaints. The drop in hemoglobin after an iron injection is not uncommon and may reflect lab variation or timing of the test. Your normal GI, brain imaging, and fundus exams are reassuring.

The presence of rouleaux formation on peripheral smear can sometimes be seen in conditions with increased plasma proteins, including multiple myeloma, but it's not diagnostic on its own. Since previous smears didn’t mention this, it could be a transient finding or lab-related variation.

To completely rule out plasma cell disorders like myeloma, you may consider further tests like serum protein electrophoresis (SPEP), serum free light chains, and ESR. However, based on your age, clinical picture, and current reports, multiple myeloma appears unlikely, and your symptoms are more consistent with iron deficiency.

Hope your query is clear now. Thank you.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Vaishalee Punj