Q. I am 32 years old. Four years ago I was diagnosed with iron deficiency anemia. I tried the supplements and the shots in the hip, however my body did not respond. My levels were not in the normal range. I am usually a 4. I now get iron intravenously every day for 1-2 weeks each month and have been consistent for 4 years now. I have had many tests, including un upper GI and colonoscopy. They were inconclusive. I tested positive for occult blood twice. I am scheduled to have a CT scan. My doctor wants to give me a hysterectomy. I am very upset. Is there anything else I should look into?

A. Iron is an important component of the diet, needed to make hemoglobin, the oxygen-carrying part of the red blood cell. The most concentrated form of dietary iron occurs in meat, and also to some degree in dark green vegetables.

Iron deficiency occurs when there is an imbalance, more iron loss that iron intake. This is a particular concern for women as iron is lost in the blood loss of the menstrual cycle and needs to be replaced. Women who have heavy menstrual bleeding may need to take iron supplements if the diet is inadequate. A low iron state often starts a search for other sources of blood loss as you describe, looking for ulcers or other problems in the intestine.

Other considerations might examine whether the bone marrow is able to produce red cells normally. This would usually be done by taking a bone marrow biopsy. A hematologist would likely be consulted for this. The occult blood tests suggests that there is continued blood loss in the intestinal tract in your case and the cause for this needs to be determined. A hysterectomy is considered only if there is heavy menstrual blood loss that cannot be controlled by other means.

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