Hello, I am looking for some guidance.
The patient is 62 years old, 180cm, and 58kg.
He had stomach cancer surgery 11 years ago; currently, his only medication for stomach issues is Apazol.
The issue is that his red blood cell counts—specifically Erythropoiesis, Hemoglobin, Hematocrit, and MCH—are steadily dropping. I’ll list them chronologically. He was previously iron deficient, but whenever his doctor prescribed supplements, the levels would improve, only to plummet again once he stopped. For example, he would take tablets for three months, the iron would stabilize, then he'd stop for another three months and the levels would drop low again.
Blood Work Results
April 1, 2022
Erythrocytes: 4.22___(4.34-5.22)
Hemoglobin: 113___(138-175)
Hematocrit: 0.344___(0.415-0.530)
MCV: 81.5___(83-97.2)
MCH: 26.8___(27.4-33.9)
Eosinophils: 0.48___(0-0.43)
Iron: 14___(11-32)
June 7, 2022
Erythrocytes: 4.26___(4.34-5.72)
Hemoglobin: 107___(138-175)
Hematocrit: 0.334___(0.415-0.530)
MCV: 78.4___(83-97.2)
MCH: 25.1___(27.4-33.9)
Eosinophils: 0.45___(0-0.43)
Iron: 24___(11-32)
October 14, 2022
Erythrocytes: 4.09___(4.34-5.72)
Hemoglobin: 100___(138-175)
Hematocrit: 0.319___(0.415-0.530)
MCV: 78___(83-97.2)
MCH: 24.4___(27.4-33.9)
MCHC: 313___(320-345)
RDW: 17.1___(9-15)
Eosinophils: 0.42___(0-0.43)
Iron: 7___(11-32)
Transferrin Saturation: 10___(20-50)
The doctor claims the blood work is fine and that he just needs to continue taking iron supplements, but I honestly have my doubts. When he stopped the supplements, his iron dropped from 24 to 7 in just four months, all while his other values (hemoglobin, hematocrit, etc.) continue to decline. I wonder if he needs a full hematology workup to find the underlying cause, or if this trend is somewhat expected for someone who has survived stomach cancer. This is a family member, and he is visibly wasting away; he has lost significant muscle mass and has almost no body fat left. On top of that, he was diagnosed with sciatica four years ago, which they say can be managed with exercise, but I'm not sure how he'll manage that given his condition.
I would truly appreciate any advice on what steps we should take next. Best regards.
The patient is 62 years old, 180cm, and 58kg.
He had stomach cancer surgery 11 years ago; currently, his only medication for stomach issues is Apazol.
The issue is that his red blood cell counts—specifically Erythropoiesis, Hemoglobin, Hematocrit, and MCH—are steadily dropping. I’ll list them chronologically. He was previously iron deficient, but whenever his doctor prescribed supplements, the levels would improve, only to plummet again once he stopped. For example, he would take tablets for three months, the iron would stabilize, then he'd stop for another three months and the levels would drop low again.
Blood Work Results
April 1, 2022
Erythrocytes: 4.22___(4.34-5.22)
Hemoglobin: 113___(138-175)
Hematocrit: 0.344___(0.415-0.530)
MCV: 81.5___(83-97.2)
MCH: 26.8___(27.4-33.9)
Eosinophils: 0.48___(0-0.43)
Iron: 14___(11-32)
June 7, 2022
Erythrocytes: 4.26___(4.34-5.72)
Hemoglobin: 107___(138-175)
Hematocrit: 0.334___(0.415-0.530)
MCV: 78.4___(83-97.2)
MCH: 25.1___(27.4-33.9)
Eosinophils: 0.45___(0-0.43)
Iron: 24___(11-32)
October 14, 2022
Erythrocytes: 4.09___(4.34-5.72)
Hemoglobin: 100___(138-175)
Hematocrit: 0.319___(0.415-0.530)
MCV: 78___(83-97.2)
MCH: 24.4___(27.4-33.9)
MCHC: 313___(320-345)
RDW: 17.1___(9-15)
Eosinophils: 0.42___(0-0.43)
Iron: 7___(11-32)
Transferrin Saturation: 10___(20-50)
The doctor claims the blood work is fine and that he just needs to continue taking iron supplements, but I honestly have my doubts. When he stopped the supplements, his iron dropped from 24 to 7 in just four months, all while his other values (hemoglobin, hematocrit, etc.) continue to decline. I wonder if he needs a full hematology workup to find the underlying cause, or if this trend is somewhat expected for someone who has survived stomach cancer. This is a family member, and he is visibly wasting away; he has lost significant muscle mass and has almost no body fat left. On top of that, he was diagnosed with sciatica four years ago, which they say can be managed with exercise, but I'm not sure how he'll manage that given his condition.
I would truly appreciate any advice on what steps we should take next. Best regards.