Brief Answer:
Anemia of a nontrivial nature- need to address

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am from XXXXXXX Ohio, USA. I would like to comment on your daughter's symptoms of fatigue, headaches, and eye pain.

Her lab results are clearly in favor of the diagnosis of some form of anemia. I don't know exactly what type although a good guess could be pernicious which is generally a lack of B12 which comes from the diet. She may possibly be iron deficient as well though her ferritin level of 56 falls within a normal range.

I would also suggest that she may suffering from a grade of dehydration which could be mild to moderate (i.e. doesn't drink enough fluid)...for her RBC's count seems elevated compared to the rest of her blood profile and this could be due to what we refer to as HEMOCONCENTRATION due to dehydration.

This may also explain why her B12 numbers of 310 appear to be quite normal when her MCV and MCH are quite low. Also, if in fact, she is dehydrated then, her ferritin may also be falsely elevated and this would be consistent with the other numbers in her profile which suggest the strong chance that she is likely iron deficient as well.

Certainly, headaches are quite commonly seen in patients are anemic and eye pain may be a consequence of her headaches especially if they are migrainous in nature. Fatigue is one of the most common and obvious symptoms of either pernicious or iron deficiency anemia.

I do not know about the left sided abdominal pain. This may be a red herring. I think it would a little too dramatic to say that as a result of the anemia she could suffering from ischemic/hypoxic bowel sorts of issues and for that reason the pain. I highly doubt that but she could have some other problems going on having to do with PMS symptoms, urinary tract infectious issues, or something transient and unrelated. Certainly, if her abdominal pain has been relieved at all by addressing the constipation then, there you have that problem solved.

My suggestion (as I'm sure her doctor's is as well) is to correct the anemia by whatever means necessary including improving and bolstering her normal diet to include plenty of B12 and iron as well as hydrating herself properly. If she does these things is likely to improve many of her symptoms.

If she were my patient I would like to know the likelihood of her being dehydrated and seeing just how altered some of her numbers from the lab results would be if she were properly hydrated. Therefore, I would do the following:

1. Ask the patient to generously hydrate herself and not make very many changes to anything else she is doing with respect to her diet, etc. I would ask her to drink plenty of water and other good healthy fluids (no coffee, no pop, no herbal teas, no alcohol, etc.). I would then, redo ALL the labs above and add the following to her profile:

a. serum methylmalonic acid, serum homocysteine IF her B12 levels came back still in the normal range

b. Total Iron Binding Capacity, Total serum Iron

c. serum ZINC levels (if zinc is low then, no amount of iron replacement will correct her anemia or raise the iron levels in blood-- Zinc must be in normal quantities)

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 32 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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