anemia and 3 positive hemocults, colonoscopy finds nothing

[Judy-Winslow]

  Went to the doctor for hand and feet tingling and sensitivity,
  found out I am anemic (8.7 - low iron).  No other symptoms except
  the tingling.  No tiredness, lack of energy, etc.  Then three
  hemocults tested positive.  A colonoscopy revealed nothing
  (checked stomach also).  How else do you explain positive
  hemocults.  Doctor is at a loss.  Forget about it or pursue
  it further?  
  Healthy and active in every other way, age 42, female.
Dear Judy,
Iron deficiency anemia usually suggests occult bleeding from the gastrointestinal tract.  A hemoglobin of 8.7 without symptoms is further suggestive of a lesion that is slowly bleeding. The first step is to rule out a colonic lesion such as colon cancer. A colonoscopy is very accurate in ruling out colon cancer. You mentioned that you had an evaluation of the stomach. Did you have an upper GI endoscopy or an upper GI series? Upper GI endoscopy is a much better test than an upper GI series to look for a bleeding source. If you have not yet had an upper GI endoscopy you should consider having that test. If that is negative the next step is to evaluate the small intestine. A small bowel push enteroscopy can sometimes find a bleeding source not seen on colonoscopy or upper GI endoscopy. A small bowel series (x-ray) may also be helpful. Sometimes an angiogram or a nuclear red cell scan is necessary to look for a cause of bleeding. However, these tests are more accurate when bleeding is active rather than occult.
If no bleeding source is detected in the gastrointestinal tract one must consider bleeding outside of the gastrointestinal tract. Examples of this could be a collection of blood in the abdomen, urinary tract bleeding, vaginal bleeding etc. Iron deficiency anemia is also common with malabsorption such as in a disease called celiac sprue. Finally, if no cause can be found you may benefit from a consultation with a hematologist.
I'm sure that by this point, you probably figured out, that I don't think that you should neglect a hemoglobin of 8.7. You should have a thorough evaluation and try to find a good explanation for this laboratory test abnormality. Good luck to you.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
Keywords: iron deficiency anemia