Heartburn is a burning discomfort behind the breast bone. This is caused by reflux of stomach acid back into the oesophagus....


Red blood cells
Iron is stored in the liver. The dark blue staining is iron in liver cells
Anaemia is a lack of red blood cells
  • Tests for blood count and tests for iron are frequently performed.  These may be part of routine testing or may be because of tiredness and a suspicion of anaemia.
  • Anaemia (low blood count or low haemoglobin  - essentially the same) is common and can be due to a range of conditions.
  • Anaemia may be due to;
    • Lack of iron.
    • Lack of folate or B12.
    • Diseases of the bone marrow.
    • Increased breakdown of red blood cells.
    • Inflammation can reduce the production of new blood cells.
  • If the anaemia is due to iron deficiency then investigation to establish a cause is essential.

    • Iron deficiency can be present but not severe enough to drop the blood count. That is, there are enough reserves of iron to make new blood cells but tests indicate that the reserves may “run-out” soon.
    • A "poor diet"is actually an uncommon cause of iron deficiency in New Zealand.
    • The main source of iron in the diet is from meat. Vegetarians should not have any problems if there is range of vegetables consumed.




Iron deficiency anaemia (lack of iron stores)

  • The most common cause of anaemia due to iron deficiency in women who are menstruating is heavy periods.
  • For men of all ages and post-menopausal women the most common cause is bleeding into the stomach or bowel.
  • In both situations the losses of blood are greater than the ability of the body to make new red blood cells and the ability of the gut to absorb the required iron to maintain the increased production of new red blood cells.
  • It is essential that there is a complete check of the digestive tract.
    • This should be by gastroscopy and colonoscopy – usually performed at the same time.
    • Your doctor may also have requested faecal occult blood tests.  This is a test to check for blood in the faeces.  This is useful but a negative test doesn't change the need for full investigation of the stomach and bowel
    • A low serum ferritin but a normal red blood cell count (or normal Hb) is a milder form of the same problem.  Usually full investigation is required but the chance of there being a serious problem is less
  • The need for these tests in a female prior to menopause will depend on the situation.
    • Specialist assessment by both a gastroenterologist and gynaecologist may be required.


The important conditions to consider are:


All these conditions are picked up by gastroscopy and colonoscopy.



What if the Gastroscopy and Colonoscopy are normal?


  • A few people have bleeding from the small bowel. If the anaemia persists and is clearly due to ongoing blood loss and if the gastroscopy and colonoscopy are normal -  then a capsule endoscopy (Pillcam) is required.
  • This is a test where a capsule camera is swallowed and images are radio-transmitted to a recording device. This test is available at Auckland Gastroenterology, Mercy Specialist Centre (Ph 09 6301838).
  • More information available on www.givenimaging.com


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