Diagnosing Anemia

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. I have a friend in her early 60s who is having a problem with anemia. She got so low on her red blood cell count she had to have a transfusion. I don't know the proper terminology, but her red blood cell count or something is at 9 and should be at 12. She doesn't seem to know what to do about it; can you help with some information about why this condition occurs?

A. Anemia is due to a lack of red blood cells. Either too many cells are being lost (such as through heavy menstrual periods or blood loss in the bowels) or inadequate numbers of blood cells are being produced (due to either a problem in the bone marrow or a deficiency of iron). In your friend's case, I am suspicious that since her blood count was normal and now is not, she may be losing blood in her stool, perhaps very slowly. She clearly needs to have this assessed and quickly. Her primary care doctor can do a rectal exam and see if she has a tiny amount in her stool with a special type of card, although she likely still needs to have a more thorough evaluation such as a barium study or endoscopy. Another source of blood loss could be in her urine; a quick "dip-stick" test of her urine can see if this is the case.

If she is not losing blood, then is there a problem making blood? A blood test such as a CBC can help distinguish if this is the case. Her doctor should check to see that her iron, folate, and B12 levels are normal -- again, these are simple blood tests. If this is still unrevealing, check for other sources such as a bone marrow problem. You are right to be concerned -- press your friend and her doctor to get moving to find out why she needs a transfusion. This means there is a significant enough condition to have caused other problems since doctors rarely transfuse blood unless the situation is serious.