Internal medicine evaluation in which causes of low hemoglobin — such as iron, B12, or folate deficiency or chronic disease — are identified and treated.
Indication
- Low hemoglobin together with fatigue, easy tiring, shortness of breath, or palpitations
- Long or heavy menstrual periods in women with intermittent dizziness
- Pale skin, burning tongue, hair loss, or brittle nails
- Iron deficiency together with gastrointestinal complaints (reflux, ulcer, chronic gastritis)
- Suspicion of B12 deficiency in vegetarian/vegan diets or older adults
- Anemia screening in pregnancy or pre-pregnancy planning
- Anemia accompanying chronic kidney disease, rheumatologic, or oncologic conditions
Preparation
- Fasting blood tests may be requested, so coming after 8-12 hours of fasting is helpful
- Report any iron, B12, folic acid, or multivitamin supplements you take
- Bring prior CBC, ferritin, B12, and folate results
- Try to recall bleeding history (menstrual, gastrointestinal, nasal) and its duration
- Prepare information on chronic conditions, prior surgeries, and family history
How it's performed
- The physician reviews complaints, dietary habits, and possible bleeding sources
- Skin, mucous membranes, tongue, lymph nodes, and abdomen are examined
- Complete blood count, ferritin, iron, B12, folate, and reticulocyte count if needed are requested
- The type of anemia is classified (iron deficiency, megaloblastic, anemia of chronic disease, etc.)
- The underlying cause is investigated with further tests (e.g., endoscopy, colonoscopy)
- Cause-directed dietary advice, oral iron/B12/folic acid supplementation, or intravenous therapy if needed are planned
Post-procedure
- Follow-up CBC and iron parameters 4-8 weeks after starting therapy
- Once target values are reached, treatment continues for 3-6 months to replenish stores
- Treatment of the underlying cause and regular follow-up to prevent recurrence
- Dose or formulation change if side effects (nausea, constipation) develop
- Referral to specialist (gastroenterology, hematology) for unexplained or recurrent anemia
Risks
- Untreated severe anemia may increase cardiac workload and lead to circulatory failure
- Oral iron therapy may cause nausea, abdominal pain, constipation, or diarrhea
- Rare allergic reactions with intravenous iron
- Long-standing untreated B12 deficiency may cause permanent nerve damage
- Endoscopy/colonoscopy may be needed to investigate the cause and carries its own risks
FAQ
What should I do if iron tablets cause side effects?
Taking with food, splitting the dose, or switching to a different iron formulation often reduces complaints. Consult your physician before changing the regimen on your own.
Can anemia be corrected with diet alone?
Diet is important in mild deficiencies and prevention; however, in moderate to severe anemia, supplementation or intravenous therapy may be needed. If bleeding or absorption problems exist, treating the underlying cause is essential.
Why does anemia recur?
Ongoing bleeding (menstrual, gastrointestinal), inadequate intake, absorption issues, or chronic illnesses are common reasons. Regular follow-up and cause-directed treatment prevent recurrence.
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