Azathioprine + Allopurinol, side effect low RBC?

[JonasBauer]

Hi!

I am 22 yrs old, was a fitness fanatic until half a year ago. Been diagnosed with diseased bowels Dec '14, and have had two inflammations, first has been put into remission with prednisone, second due to humira (budesonide didn't work, prednisone didn't work, prednisone + enemas didn't work). Both times endoscopies have been performed; I'm treated as having Colitis Ulcerosa, but biopsies were both times negative.

Since 9 months, my maintenance medication is azathioprine + 100mg allopurinol. First it was only azathioprine. The goal is to reduce white blood cell count, because of the autoimmune nature of the disease.

The last half year I've been having severe breathing problems, dizziness, and I'm bloated a lot (in my stomach). In the hospital a test determined that I hyperventilate. I haven't been able to exercise for the past months, because it induces hyperventilation attacks. Before this, I even went to the gym 4 times a week during inflammation periods, but now I cant because Im not getting air. I even get dizzy and feel short of breath when doing computer work - so frustrating.

I compared the lab results of my blood work from last year with that of a month ago. I've read that as an adverse effect, azathioprine+allopurinol can also lower red blood cell count (RBC) instead of just white blood cell count.

Last year's RBC: 4.76
RBC a month ago: 3.8 (ref. range = 4.5-5.9)
--> a reduce of >20% in RBC

To me this would be an explanation of why I started hyperventilating: Red blood cells carry oxygen. My body's capacity to transport oxygen has signficantly reduced, so a natural response of my body is to by all means try to get more oxygen in.

I emailed my MD with this hypothesis, and she responded that that it would be very unlikely that that had anything to do with my problems. Should I go for a second opinion? I battle for air every single day.. And am so tired of it all. This feels so much worse than shitting blood a couple of times a day!

Thanks..

 

[Catherine]

Do you have rest of the blood results?

Also do you have results for iron, folate and b12?

 

[JonasBauer]

Thanks for your reply!

Last week I spoke with a friend of mine who is a doctor, he looked at the Hemoglobin levels. The level was 8.9 a year ago, and is 8.1 now.

He told me that, since 'H2O-transport-capacity' is a direct function of Hemoglobine, and not a function of e.g. (amount of red blood cells; Hemoglobin, Hematocrit), any problems I cope with are probably not related to the lower amount of red blood cells.


For a long time I have just neglected small side effects other than colitis problems, because I wanto to be strong and am so glad that my colitis is under control. But last week I decided I need to look for help. I have dry skin, very dark urine, ithcyness all over my body throughout the whole day, and worst of all feeling disoriented and problems with concentrating.. My mind is foggy all the time. Sometimes it gets so bad, most of the time later in the day, that I have trouble breathing and everything feels like its taking place behind a thick glass wall. I am there, but signals don't really reach me. In these episodes I'm also nauseous and can't estimate depth properly. When I then go lay in bed that eases breathing problems but the nauseousness does not go away. I can't do my job properly and have so much trouble studying because I can't concentrate like I used to.

I called the hospital today to make an appointment with my colitis specialist to discuss again if these effect can have anything to do with allopurinol and/or imuran (azathiorpine) , but the first time I can see her is half-way into February..

I have talked about this with her earlier when I just experienced the nauseousness and light-headedness, but she told me to go see a psychologist before stopping with the meds. Actually I'm kind of sure these effects are medicine-induced, because before medication, I never experienced any health problems whatsoever.. Perhaps only sick once in two-three years.

So today I had a little break-down moment after calling the hospital. I still have tears in my eyes. I neglected these problems for a long time, but the strenght to do that has run out. I feel so misunderstood; the doctor does not recognize that my concentrating problems and other problems might be related to my medication intake.. She also doesn't take it as serious as it is. I'm actually struggling with this daily, and she sees it as just a small side. And the first time I can talk to her again about this is in 2 months..!

 

[JonasBauer]

And I'm taking my 100g Azathioprine (imuran) and 100mg Allopurinol in the morning after breakfast. Could it do harm to try out of I feel better when I take them before I go to bed instead of in the morning?

 

[Catherine]

The lower hemoglobin is mostly likely caused by Crohn's. Anemia is not normal and should be treated.

My then 16 year old daughter was able to swim (8 x 2 hours sessions per week) at hemoglobin level of 9.5. But she is much better with a higher hemoglobin level.

I think you issue is your treatment plan is not working because is was your hemoglobin levels would be increasing.

 

[JonasBauer]

Thanks again for your reply Catherine.

I see now, that I forgot to convert hemoglobin values to g/dl (standard in the US) before posting. Mine were measured in the Netherlands, where it is reported in mmol/L. My actual hemoglobin level in g/dl = 12.96; which should be fine.

I've made an appointment with my GP for monday morning to discuss things.