Ask the Doctor: Low Red Blood Cell Count; Douching & Ovarian Cancer; Warfarin

Q: Recent blood work has revealed that I have a low red blood cell count. What might be causing this?

A: A low red blood cell count may have several causes, including conditions that reduce the production of red blood cells and blood loss. The common term for a low red blood cell count is anemia. Symptoms of anemia include dizziness, fatigue, and shortness of breath.

Blood tests can point to the source of your anemia by measuring iron, folate, and vitamin B12 (the last two are vitamins needed for red blood cell production).

If your low blood count is due to a deficiency of vitamin B12—a condition common in older adults—make sure that your diet includes plenty of B12-rich foods (for example, fish and shellfish, lean meat and poultry, low-fat dairy products, and eggs). Your doctor also may recommend a B12 supplement or monthly B12 shots. Folate is present in leafy, green vegetables such as spinach, broccoli, Brussels sprouts, and mustard greens, as well as fortified breakfast cereals.

If you have an iron deficiency, your anemia might be caused by internal blood loss. If your doctor suspects this, he or she may request an endoscopy (which looks for signs of bleeding in the stomach), colonoscopy (which can identify bleeding in the colon), or a stool occult test that can detect hidden blood. If test results are inconclusive, your doctor will need to investigate further. Health conditions that are associated with a low red blood cell count include ulcers in the digestive tract, chronic kidney disease, underactive thyroid, and some types of cancer.

Q: Is it true that douching can cause ovarian cancer?

A: A study published earlier this year found a link between douching and ovarian cancer, with women who douched having almost twice the risk of women who did not douche. However, the number of study participants with ovarian cancer and a history of douching was small, and the study also did not account for some of the health and lifestyle factors that may influence ovarian cancer risk, such as a family history of ovarian cancer, more than one first-degree relative with breast cancer, and smoking. The take-home message: The study did not prove a cause-and-effect relationship between douching and ovarian cancer.

That said, douching is not recommended, since it flushes out normal bacteria that help keep the vagina healthy, and it increases the risk of infection. Instead, use plain, unscented soap to wash the surrounding areas—the vagina cleans itself with natural secretions. If you have a persistent problem with vaginal odor, see your gynecologist to be evaluated for possible causes, such as vaginosis, an infection that results from an overgrowth of bacteria in the vagina.

Q: I was recently diagnosed with atrial fibrillation and prescribed warfarin (Coumadin) to prevent blood clots. Since I’ve been taking the medication, my toes have turned a purplish color. Could this be a sign of a serious problem?

A: Based on your description, it sounds like you may have “purple toe syndrome,” a rare side effect of warfarin that can appear in the first few weeks after starting the drug. It’s caused by microscopic pieces of plaque blocking the tiny blood vessels in the toes, which traps blood in the toes, leading to the purplish color.

Report the discoloration in your toes to your doctor so it can be further investigated. It is possible he or she may prescribe a different anticoagulant for you (see article on page 6 for more information on other anticoagulant drugs). However, don’t stop taking your medication before seeing your doctor, since it’s your best defense against blood clots and stroke.

 

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