Why Am I Having So Much Trouble Keeping My Hematocrit Up?

Posted on Sat, 1 Mar 2014

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

Sat, 1 Mar 2014 Answered on

Wed, 19 Mar 2014 Last reviewed on

Question : I am cold all the time, have to wear jackets indoors. I asked about this problem, and the doctor gave a good answer--he suggested that thyroid might be involved. That's just what my doctor thought, he gave me a thyroid test, all results normal. I get anemic easily. I have to take lots of iron to keep my hematocrit up. Sometimes it doesn't seem to help too much. Currently it is 31.6. I guess maybe the real question is: why am I having so much trouble keeping my hematocrit up, even when I take iron plus a multi-vitamin?

Answered by Dr. Robert Galamaga (6 hours later)

Brief Answer: Followup Detailed Answer: Hello and thank you for sending the question. This is an excellent question our work on trying to put together plan to investigate why you have a low hematocrit. The main and obvious thing that we need to pool out is some type of blood boss that is going on in your body. This can happen in your urinary tract or your gastrointestinal tract. I think it is important that you have a gastrointestinal workup done. This would involve a colonoscopy or upper endoscopy. I would suspect you have had this done at some point in the past but if you were he Metacritic remains low they may consider doing it again just to make sure there is not some type of bleeding going on such as an ulcer or some type of bleeding in the colon. also it would be important to make sure there is no bleeding going on in your urinary tract. Even if you don't see blood in your urine it could be going on at a very low level. A simple urinalysis can rule this out. I also assume that you are not experiencing any vaginal bleeding. This is another cause of low hematocrit sometimes. The other concern is with low hematocrit we need to make sure there is no place in your bodyweight read blood cells are being destroyed. This can sometimes happen in the spleen for example if the spleen is hyperactive. if there is no sign of active bleeding I think it would be reasonable for you to visit with a local hematologist. This doctor can look at your blood under the microscope in addition to a pathologist and determine if there is some type of destruction of your red blood cells going on. also I assume you have discussed the fact that dietary iron is very important to maintain your hematocrit. If this is an issue it is important that you take iron with vitamin C. Vitamin C helps your body absorb the iron. I usually tell my patients to take iron with a glass of orange juice or a tablet of vitamin C two or three times per day. thank you again for sending the question. I look forward to continuing to work on this healthcare concern with you. Dr. Galamaga

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Robert Galamaga (3 hours later)

Dear Dr. Malaga, thank you for your comprehensive analysis. I have an answer to some of the questions you asked, thought that I'd give you some more info. I had a colonoscopy done within the last year, one 1 mm polyp, benign, all else normal. I don't know this but I'm guessing that if I had an ulcer I would have an uncomfortable stomach, much of the time. I don't have any burning in my stomach, it doesn't hurt, or feel as it did many years ago when I had a pre-ulcerous condition. I have no acid reflux symptoms. As to my urinary tract, I had one incidence of gross hematuria, last August, where my urine looked like Coca-Cola and was bubbly. About two weeks ago I had a urine test done to look for microscopic blood in my urine, but it was negative. No trace of blood they said. No trace, thank goodness, of any vaginal bleeding! I have heard that kidney problems sometimes cause low red blood cell counts. Could this be a source of concern? That is great advice about my spleen, no one, nobody has mentioned this as a potential source of the problem. Would my PCP be used to evaluating this kind of thing, or should I go to a hematologist for this? Thank you for your thoughtful analysis. XXXXXXX

Answered by Dr. Robert Galamaga (38 hours later)

Brief Answer: Followup Detailed Answer: hello again and thank you for the additional information. Despite what you have mentioned it is still possible to have ulcers or bleeding without necessarily having pain. You're absolutely correct that typically this type of thing is associated with pain but this is not 100% in all cases. you are also correct regarding the kidneys. The kidneys play a vital role in producing red blood cells. If there is limitation of kidney function it can sometimes lower the total amount of erythropoietin in the blood. This particular hormone signals the bone marrow to produce red blood cells. If the kidney function is limited this can cause a diminished circulating amount of this hormone which can then lead to lower blood counts. It sounds like you do not have any active bleeding from what you described. Regarding looking for other causes of destruction of red blood cells in the body including the spleen it would be reasonable to review this with a local hematologist. This would be someone that your primary care doctor is comfortable with reviewing your information. I would discuss this with your primary care doctor to see if local referral is warranted. Sincerely, Dr. Galamaga

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar