Dear Friends and colleagues,
We discussed iron and vitamin B12 as the two most important causes of anemia or low hemoglobin. I always tell my patients that anemia or low Hemoglobin is NOT a disease but a manifestation of some underlying disease, disorder or deficiency.
A 54 year old lady, co-owner of a saree shop came to Lotus hospital around 2 years ago with severe fatigue, weakness (non -specific) and getting tired easily. She had no obvious findings on general examination. Her Hb level was only 5.4 gm (normal 12-14)
She had a battery of tests to determine the cause of her anemia and they were all normal including liver function, kidney function, iron Vitamin B12. She was not losing blood in her stool. Sonography of her tummy and chest X ray were also normal.
We do a special test called Bone marrow examination, where we take out blood from our “Blood Factory” i.e Bone Marrow and see the specific blood cells under a microscope. We use a special needle for the same. We give local anesthesia for the same. Bone marrow is where all our blood cells are formed.
She had a cancer in bone marrow! The cancer cells had “come” to her bone marrow from some other cancer in the body, which is called “Metastasis” in medical terms. On further investigations she had a small breast cancer which was diagnosed on mammography test.
So her anemia or low hemoglobin was due to inadequate production as her bone marrow space was taken over by her breast cancer cells.
So cancer causing low hemoglobin is rare but possible. 90% of times low hemoglobin is easily curable and we donot need to think of serious causes. At the same time timely tests are necessary so as to make early diagnosis.
Dr Pritesh Junagade
Lotus Hospital
August 2023
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