Anemia secondary to Ultram

  I am a Physician's Assistant.  My husband is a 46 y/o WM with arachnoiditis presumed secondary to a myelogram done over 20 years ago.  He has nocturnal leg pain controlled extremely well ever since he started taking Ultram 50 mg 2 tabs BID 2 years ago.  Since starting the Ultram, his H/H has been 13.2/38.0.  RBC - 4.37.  Indices, RDW, platelets, iron studies are WNL.  Retic count this time was 1.9.  The PDR lists decreased Hgb as a side effect of Ultram.  Is it appropriate to continue the Ultram? He is so pleased with it as NSAIDS, Elavil, Dilantin never helped. Thanks.
  This is a terrific service for patients and by the way, I do not manage my husband's care but his Neurologist has not addressed this issue (perhaps because it is not important???)
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Thanks for the question Elaine. Ultram has many of the same side effects as a host of what is termed nonstroidal anti-inflammatory medications, one of which is GI irritation. As far as I know it does not cause a drop in HgB do to any bone marrow affects but rather by causing a loss in the GI tract. Certainly a change in the bowel appearance (black) stools would suggest bleeding. In general we do not monitor blood counts in paients taking these medications but if you are concerned I would recommend discussing it with his doctors but I hear nothing bad in what you are telling me. Good luck.