Conversation: The conversation between human and AI assistant.
[|Human|] My dad (age:75) has been getting blood transfusions since May (2 units about 1 a month). He is anemic, tired, has achy joints, had headaches, and passed out temporaraily once. He has had an upper & lower GI, bone marrow test, did a stool sample, had a colonoscopy and ct scan and x-rays. He has a hemotologist, MD, cancer specialist and VA doctor stumped. They do not find where he is passing blood, and the bone marrow test was ok. I thought perhaps he had pernicious anemia, but the doctor says his B12 levels were fine. We are all stumped, and dad is very frustrated. Any suggestions?
[|AI|]  Hi considering your dads age, there are few things that can be possible. In the setting of a normal extensive lower GI examination and tests I would suggest you to perform another bone marrow test and iron studies along with transferring receptor studies to rule out anemia due to dysplasias that is common with aging people. Myelodysplasia can be often missed by pathologists as it can be very subtle, and it needs to be reviewed by multiple pathologists or hematopathologists. Can you ask the bone marrow guys to send the slides to some histopathology specialized center like MD Anderson cancer center or memorials loan Kettering cancer center? Also, it is important to rule our iron deficiency due to chronic blood loss from middle or upper GI tract as well as to consider anemia of chronic diseases by doing complete iron and storage studies. Do let me know if you have any more questions for me. I hope the advice is helpful