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Crohn's Disease
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Posted 8/5/2016 6:27 PM (GMT 0)
Hi All,

18 year history of Crohn's for my husband, currently on Remicade. He's had anemia in the past requiring iron infusions. This spring, he had a round of iron infusions because his hemoglobin was down to 10. A month after completing the round of iron infusions, his hemoglobin has dropped back down to 9 (was back up to 12).

Everything has been ruled out as far as bleeding-which he is not bleeding. I am wondering if anyone has experienced this, what they have done, and any tips.........thanks so much!
Posted 8/5/2016 7:07 PM (GMT 0)
Are they sure that his inflammation in his small bowel (specifically his illeum) are free from inflammation?
He might have something going on preventing absorption of iron. Because if they ruled out all causes of bleeding it is likely an absorption issue.
Is his diet very high in calcium
Is he vegan?

Sometimes celiac disease can cause malabsorption of iron

What are his iron, ferritin, b12 and folate levels
Posted 8/5/2016 7:19 PM (GMT 0)
He had EGD, colonoscopy, and MR enterogrophy all showing no inflammation. Just some gastritis. Not a high calcium diet, not Vegan.
Posted 8/5/2016 7:50 PM (GMT 0)
is he seeing a hematologist for this? i recommend he go see one. they are better prepared to dissect the blood and absorption issues once you have ruled out bleeding. They will also get very specific on the cause of the iron defficiency
Posted 8/5/2016 10:05 PM (GMT 0)
Agree with seeing hematologist
Posted 8/8/2016 5:11 PM (GMT 0)
Have you all seen a hematologist? What did they say/do for you all?
Posted 8/8/2016 10:40 PM (GMT 0)
I have seen a hematologist. Becuse I wasn't able to tolerate the ferrous sulphate (40 mg every other day)
They did feraheme infusion.
He wanted to know the source of my bleeding
That is how they ended up diagnosing me with Crohns. Originally I was diagnosed with UC but they suspected something was up with small bowel becuse of anemia
Imaging showed small bowel inflammation, goal now is to get small bowel inflammation down. Will be rechecking my iron levels again soon.
But any good hematologist is going to want to find the source of anemia and not just to treat the anemia
Posted 8/9/2016 5:30 PM (GMT 0)
That is my beef with our GI right now....yes, my husband has anemia and we will "fix" it with supplemental iron. But why does his hemoglobin keep dropping?!!
Posted 8/9/2016 6:58 PM (GMT 0)
dunno if you need a referral but I would recommend seeing a hematologist.
try to find one who has experience with dealing with GI patients, you can ask the receptionist when you schedule the appointment if the doc deals with GI patients ever?

what are they doing about the gastritis, are they sure there isn't a small ulcer that is bleeding?
Is the GI an IBD specialist practicing out of an academic center?
Posted 8/9/2016 10:40 PM (GMT 0)
I just want to mention one possibility that nobody has mentioned so far: Remicade (and 6MP or azathioprine, if your husband is on either of those drugs to supplement the Remicade). All three drugs that I mentioned - particularly the last two - can cause myelosuppression, i.e. bone marrow suppression. The bone marrow produces blood cells; if myelosuppression affects the red blood cells it will cause anaemia.

I had that happen to me on methotrexate. Within a few weeks my haemoglobin was down from 11 to 7 and I was given a blood transfusion in hospital. As the MTX wasn't doing a thing for my Crohn's otherwise, I was taken off it fairly soon afterwards.

One other possibility is anaemia of chronic disease. But if Remicade is treating your husband's Crohn's successfully, then that shouldn't happen, so I dunno.

A haematologist does sound like a good idea at this point.
Posted 8/10/2016 1:17 AM (GMT 0)
Hi,

Has your husband had any of his bowel removed? My Hematologist told me I could take all the supplements I want, but I'm missing the parts of bowel to absorb them. I too have iron infusions.

Julia
Posted 8/10/2016 1:40 AM (GMT 0)
Thank you for the thought about Remicade. I will bring that question to the hematologist and gastroenterologist.

He is missing the part where the large and small intestines meet.....
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