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question re: red blood low due to no illium??

Posts: 259
Joined: Nov 2004

I'm 10/12 of the way through FOLFOX 6 (stage III colon cancer plus Crone's disease). I was anemic before going into surgery and my red blood count has been low throughout chemo, despite my being on 2 iron pill supplements a day since late June.

A visiting doctor at my clinic suggested that because they removed my illium (sp.?) during surgery, it may be that my body can't use the vitamin B 12 to combine with the iron to help boost my red blood cells. So he says I should get a B 12 shot once a month for the rest of my life, plus do 8 weeks of intervenous iron at the oncology clinic. My oncologist agreed with this theory and treatment.

Has anyone run into this problem and treatment before? Does anyone know of any side effects or alternative theories I should be thinking about? Getting what amounts to vitamin and mineral supplements sounds harmless enough after chemo, but I have learned that one should check out even the stuff that sounds like a no brainer. Also, if the illium is needed to provide this function, and they knew they took out my illium, how come it took all this time to come up with a solution for my sinking red blood count? Thanks.

Posts: 120
Joined: May 2004

Hi I don't have an answer but to think you take the extra iron & vitamins good help! I wish you well and hang in there!

Posts: 137
Joined: Mar 2004

Hi, Due to adhesions and radiation damage they had to remove a lot of my intestine, and it did effect my absorption of vitamines. I occasionally have to get B12 shots, no side affects. How come they waited so long? Good question, but it seems that at least in my case they've always waited til the problem was serious, or until I expressed concern. I think this may be an example of how important it is to remember to take a very active role in managing our case, and trying to be as informed as possible in order to talk with the Docs. They tend to be overworked, and our test numbers can tend to slip through the cracks.

Posts: 708
Joined: May 2004

Hi there, Dr. Jana here... the reason they didn't do something sooner is that people have huge reserves of Vit B12 in there body. If you had iron def. anemia first, which causes microcytic (small cell) anemia; and then developed Vit B12 def anemia, which causes macrocytic (large cell) anemia, it isn't completely clear. In addition, chemo causes the bone marrow to get tired, normocytic (normal cell) anemia. This one is treated with Procrit injections. So you have lots of different problems causing anemia.
The body needs to use intrinsic factor to absorb Vit B12 - this is done in the intestine and resection affects this process.
You shouldn't have side effects from the B12 injections. Iron can cause constipation, which shouldn't be a problem if you are on chemo currently.
Sorry for all the med speak, just trying to help you understand.

Posts: 106
Joined: Nov 2004

Hello,my name is Frantic (Fran). I was dx.with stage 4 colon cancer in Aug.2003. I had my ascending colon,sigmoid colon and part of my ileum removed. I now have an illesotomy. I was not anemic before the surgery even with the bloody bowel movements they though was an
INTERNAL HEMMOROID. I had complications after surgery which included bowel obstructions and pulmonary embolisms. I had chemo which consisted of lecovorin,5Fu and campsotar(cpt11). I heard for this stage it was light treatment compared to what everybody else had. I also had radiation 5-6
weeks to the pelvic area. This process of chemo and radiation took from Oct.2003- June-2003.
In June 03 with my last chemo the partner of my oncoligist decided to give me procrit shots. My hemoglobin always ranged between 12 and 10 throughout the chemo. This Dr. started to give me procrit shots for 10 weeks in which my hgb.consistently dropped. The Dr. thought I was bleeding from the GI and recommended to be scoped.
That is the first place they look. I told the Dr. I am not bleeding as I have an illeostomy and you would see that amt. of blood loss in the bag. I went for the scope (upper endo and rectum )Of
course there was no bleeding. My rectum is closed off. My count was still down below 8.0.
I had to get transfusions of red blood cells in Aug.2004 and Oct. 2004 and just had another tranfusion yetserday Jan.21,2005. I have had 3 bone marrow biopsies. 2 of which showed Red blood cell aplasia. My bone marrow is not making red blood cells. The white cells and platlets are fine. Even though I do not have an ileum my ferritin and Vit.B12 have been normal. My oncolgist said the count tumbled down when I was given procrit shots. He feels I had a very rare reaction to the procrit shots as my body made antibodies against the red cells. I am not making new red blood cells. I had 2 bone marrow biopsies through the 2 sides of the pelvis area where it was radiated. I have been to Sloan Kettering for a second opinion where that DR. sais it was a complicated case and had no answers. I just had my 3rd bone marrow biopsy thru the sternum on Friday. I am awaiting results. My oncologist said this will determine the treatment as this part of the body was not radiated. If you want to E-mail feel free to. I would be more than happy with you to share my experience. As they still have no answers for me.(Very frustrated on top of the colon cancer) Do you have an illeostomy?? Every case is different. There is also a web site called SHAZ'S OSTOMY SUPPOR GROUP. Even if you do not have an illeostomy or colostomy, the people in that group are very knowlegable about absorbtion of vitamins and minerals without an illeum. They all had either Chron's disease, Ulcerative colitis or cancer of the colon. They are great to talk to just as this network.
Your Friend Fran

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