Q: I am suffering from acute anaemia. I have undergone endoscopy and colonoscopy. Everything is normal. I was administered 6 units of blood. Yet, after a month, I started showing signs of anaemia again. My stool test shows occult blood positive. It is accompanied by swelling of feet. I get tired even with slight exercise. My blood pressure and heart are normal. A stone has been detected in my kidney. But I don't have any pain. Am I suffering from haemophilia? Where can I go for a good diagnosis?

A:Acute anaemia is a sudden precipitous fall in the number of circulating red cells and is often due to blood loss (haemorrhage) or red cell breakdown (hemolysis). The red cells transport oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs via haemoglobin. When there is severe anaemia, there is a reduction in this oxygen-carrying capacity of the blood. Haemorrhage may be from the gastrointestinal or genitourinary tract secondary to diseases affecting these systems or due to congenital bleeding disorders like haemophilia or von Willebrand disease. Acute hemolysis may be due to auto immune hemolytic anaemia (auto immune diseases or drug-related or idiopathic), hemoglobinopathies, red cell enzymopathies, acquired platelet disorders, HUS, DIC etc. You should be clinically examined. As the stool occult blood is positive and there is a kidney stone, the likelihood of blood loss is very high. Other causes can be excluded by a complete blood count with peripheral smear examination, reticulocyte count, serum bilirubin, serum LDH, urine examination etc. Most major hospitals have a department of Haematology where you can be investigated and treated.