Have you ever been told that an older relative has anemia?
Or perhaps you noticed the red blood cell count flagged as “low” in the bloodwork report? Or noticed “low hemoglobin” in a doctor’s report?
Anemia means having a red blood cell count that is lower than normal, and it’s very common in older adults. About 10% of independently living people over age 65 have anemia. And anemia becomes even more common as people get older.
But many older adults and families hardly understand anemia.
This isn’t surprising: anemia is associated with a dizzying array of underlying health conditions, and can represent anything from a life-threatening emergency to a mild chronic problem that barely makes the primary care doctor blink.
Still, it worries me that older adults and families don’t know more about anemia. If you or your relative has this condition, it’s important to understand what’s going on and what the follow-up plan is. (I’ve so often discovered that a patient didn’t know he or she had had anemia!) Misunderstanding anemia can also lead to unnecessary worrying, or perhaps even inappropriate treatment with iron supplements.
And since anemia is often caused by some other problem in the body, not understanding anemia often means that people don’t understand something else that is important regarding their health.
Fortunately, you don’t have to be a doctor to have a decent understanding of the basics of anemia.
This post will help you understand:
- How anemia is detected and diagnosed in aging adults.
- Symptoms of anemia.
- The most common causes of anemia, and tests often used to check for them.
- What to ask the doctor.
- How to get better follow-up, if you or your relative is diagnosed with anemia.
Defining and detecting anemia
Anemia means having a lower-than-normal count of red blood cells circulating in the blood.
Red blood cells are always counted as part of a “Complete Blood Count” (CBC) test, which is a very commonly ordered blood test.
A CBC test usually includes the following results:
- White blood cell count (WBCs): the number of white blood cells per microliter of blood
- Red blood cell count (RBCs): the number of red blood cells per microliter of blood
- Hemoglobin (Hgb): how many grams of this oxygen-carrying protein per deciliter of blood
- Hematocrit (Hct): the fraction of blood that is made up of red blood cells
- Mean corpuscular volume (MCV): the average size of red blood cells
- Platelet count (Plts): how many platelets (a smaller cell involved in clotting blood) per microliter of blood
(For more information on the CBC test, see this Medline page. For more on common blood tests, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.)
By convention, to detect anemia clinicians rely on the hemoglobin level and the hematocrit, rather than on the red blood cell count.
A “normal” level of hemoglobin is usually in the range of 14-17gm/dL for men, and 12-15gm/dL for women. However, different laboratories may define the normal range slightly differently.
A low hemoglobin level — meaning, it’s below normal — can be used to detect anemia. Clinicians often confirm the lower hemoglobin level by repeating the CBC test.
If clinicians detect anemia, they usually will review the mean corpuscular volume measurement (included in the CBC) to see if the red cells are smaller or bigger than normal. We do this because the size of the red blood cells can help point doctors towards the underlying cause of anemia.
Hence anemia is often described as:
- Microcytic: red cells smaller than normal
- Normocytic: red cells of a normal size
- Macrocytic: red cells larger than normal
Symptoms of anemia
The red blood cells in your blood use hemoglobin to carry oxygen from your lungs to every cell in your body. So when a person doesn’t have enough properly functioning red blood cells, the body begins to experience symptoms related to not having enough oxygen.
Common symptoms of anemia are:
- fatigue
- weakness
- shortness of breath
- high heartrate
- headaches
- becoming paler, which is often first seen by checking inside the lower lids
- lower blood pressure (especially if the anemia is caused by bleeding)
However, it’s very common for people to have mild anemia — meaning a hemoglobin level that’s not way below normal — and in this case, symptoms may be barely noticeable or non-existent.
That’s because the severity of symptoms depends on two crucial factors:
- How far below normal is the hemoglobin level?
- How quickly did the hemoglobin drop to this level?
This second factor is very important to keep in mind. The human body does somewhat adapt to lower hemoglobin levels, but only if it’s given weeks or months to do so.
So this means that if someone’s hemoglobin drops from 12.5gm/dL to 10gm/dL (which we’d generally consider a moderate level of anemia), they are likely to feel pretty crummy if this drop happened over two days, but much less so if it developed slowly over two months.
People sometimes want to know how low the hemoglobin has to be for anemia to be “severe.” This really depends on the past medical history of the person and on how fast the hemoglobin dropped, but generally, a hemoglobin of 6.5 to 7.9 gm/dL is often considered “severe” anemia.
People also sometimes want to know how low can hemoglobin go before causing death. In general, a hemoglobin less than 6.5 gm/dL is considered life-threatening. But again, how long the body can tolerate a low hemoglobin depends on many factors, and including whether the hemoglobin is continuing to drop quickly (due an internal bleed, for instance) or is slowly drifting down. A study of Jehovah’s Witnesses who died after refusing transfusions found that those with hemoglobins between 4.1 to 5 gm/dL died, on average, about 11 days later.
The most common causes of anemia in aging adults
Whenever anemia is detected, it’s essential to figure out what is causing the low red blood cell count.
Compared to most cells in the body, normal red blood cells have a short lifespan: about 100-120 days. So a healthy body must always be producing red blood cells. This is done in the bone marrow and takes about seven days, then the new red blood cells work in the blood for 3-4 months. Once the red blood cell dies, the body recovers the iron and reuses it to create new red blood cells.
Anemia happens when something goes wrong with these normal processes. In kids and younger adults, there is usually one cause for anemia. But in older adults, it’s quite common for there to be several co-existing causes of anemia.
A useful way to think about anemia is by considering two categories of causes:
- A problem producing the red blood cells, and/or
- A problem losing red blood cells
Here are the most common causes of low hemoglobin for each category:
Problems producing red blood cells. These includes problems related to the bone marrow (where red blood cells are made) and deficiencies in vitamins and other substances used to make red blood cells. Common specific causes include:
- Chemotherapy or other medications affecting the bone marrow cells responsible for making red blood cells.
- Iron deficiency. This occasionally happens to vegetarians and others who don’t eat much meat. But it’s more commonly due to chronic blood loss, such as heavy periods in younger women, or a slowly bleeding ulcer in the stomach or small intestine, or even a chronic bleeding spot in the colon.
- Lack of vitamins needed for red blood cells. Vitamin B12 and folate are both essential to red blood cell formation.
- Low levels of erythropoietin. Erythropoietin is usually produced by the kidneys, and helps stimulate the bone marrow to make red blood cells. (This is the “epo” substance used in “blood doping” by unethical athletes.) People with kidney disease often have low levels of erythropoietin, which can cause a related anemia.
- Chronic inflammation. Many chronic illnesses are associated with a low or moderate level of chronic inflammation. Cancers and chronic infections can also cause inflammation. Inflammation seems to interfere with making red blood cells, a phenomenon known as “anemia of chronic disease.”
- Bone marrow disorders. Any disorder affecting the bone marrow or blood cells can interfere with red blood cell production and hence cause anemia.
Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:
- Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
- Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
- taking a daily aspirin or non-steroidal anti-inflammatory drug
- peptic ulcer disease
- cancer in the stomach or bowel
- Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
- Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.
There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.
A major study of causes of anemia in non-institutionalized older Americans found the following:
- One-third of the anemias were due to deficiency of iron, vitamin B12, and/or folate.
- One-third were due to chronic kidney disease or anemia of chronic disease.
- One-third of the anemias were “unexplained.”
How doctors evaluate anemia
Once anemia is detected, it’s important for health professionals to do some additional evaluation and follow-up, to figure out what might be causing the anemia.
Understanding the timeline of the anemia — did it come on quickly or slowly? Is the red blood count stable or still trending down with time? — helps doctors figure out what’s going on, and how urgent the situation is.
Common follow-up tests include:
- Checking the stool for signs of microscopic blood loss
- Checking a ferritin level (which reflects iron stores in the body)
- Checking vitamin B12 and folate levels
- Checking kidney function, which is initially done by reviewing the estimated glomerular filtration rate (included in most basic bloodwork results)
- Checking the reticulocyte count, which reflects whether the bone marrow trying to produce extra red blood cells to compensate for anemia
- Checking levels of an “inflammation marker” in the blood, such as the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- Evaluation of the peripheral smear, which means the cells in the blood are examined via microscope
- Urine tests, to check for proteins associated with certain blood cell disorders
If the anemia is bad enough, or if the person is suffering significant symptoms, doctors might also consider a blood transfusion. However, although even mild anemia has been associated with worse health outcomes, research suggests that transfusing mild to moderate anemia generally isn’t beneficial. (This issue especially comes up when people are hospitalized or acutely ill.)
What to ask the doctor about anemia
If you are told that you or your older relative has anemia, be sure you understand how severe it seems to be, and what the doctors think might be causing it. This will help you understand the plan for follow-up and treatment.
Some specific questions that can be handy include:
- How bad is this anemia? Does it seem to be mild, moderate, or severe?
- What do you think is causing it? Could there be multiple causes or factors involved?
- How long do you think I’ve had this anemia? Does it seem to be stable or is it getting worse?
- Is this the cause of my symptoms or do you think something else is causing my symptoms?
- Could any of my medications be involved?
- What is our plan for further evaluation?
- What is our plan for treating this anemia?
- When do you recommend we check the CBC again? What is our plan for monitoring the anemia?
Be sure to request and keep copies of your lab results. It will help you and your doctors in the future to be able to review your past labs related to anemia and any related testing.
Avoiding common pitfalls related to anemia and iron
A very common diagnosis in older adults is iron-deficiency anemia. If you are diagnosed with this type of anemia, be sure the doctors have checked a ferritin level or otherwise confirmed you are low on iron.
I have actually reviewed medical charts in which a patient was prescribed iron for anemia, but no actual low iron level was documented. This suggests that the clinician may have presumed the anemia was due to low iron.
However, although iron deficiency is common, it’s important that clinicians and patients confirm this is the cause, before moving on to treatment with iron supplements. Doctors should also assess for other causes of anemia, since it’s very common for older adults to simultaneously experience multiple causes of anemia (e.g. iron deficiency and vitamin B12 deficiency).
If an iron deficiency is confirmed, be sure the doctors have tried to check for any causes of slow blood loss.
It is common for older adults to develop microscopic bleeds in their stomach or colon, especially if they take a daily aspirin or a non-steroidal anti-inflammatory drug (NSAIDs) such as ibuprofen. (For this reason — and others — NSAIDs are on the Beer’s list of medications that older adults should use with caution.)
Bear in mind that iron supplements are often quite constipating for older adults. So you only want to take them if an iron-deficiency anemia has been confirmed, and you want to make sure any causes of ongoing blood loss (which causes iron loss) have been addressed.
The most important take home points on anemia in older adults
Here’s what I hope you’ll take away from this article:
1.Anemia is a very common condition for older adults, and often has multiple underlying causes.
2. Anemia is often mild-to-moderate and chronic; don’t let the follow-up fall through the cracks.
3. If you are diagnosed with anemia or if you notice a lower than normal hemoglobin on your lab report, be sure to ask questions to understand your anemia. You’ll want to know:
- Is the anemia chronic or new?
- Is it mild, moderate, or severe?
- What is thought to be the cause? Have you been checked for common problems such as low iron or low vitamin B12?
4. If you are diagnosed with low iron levels: could it be from a small internal bleed and could that be associated with aspirin, a non-steroidal anti-inflammatory medication such as ibuprofen, or another medication?
5. Keep copies of your lab reports.
6. Make sure you know what the plan is, for following your blood count and for evaluating the cause of your anemia.
Note: We have reached over 200 comments on this post, so comments will now be closed. If you have a question, chances are it’s already been asked and answered. Thank you!
You may also find it helpful to read these related articles:
Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults
How to Avoid Harm from Vitamin B12 Deficiency
This article was first published in 2016 & minor updates were made in Jan 2023. (The fundamentals of anemia in older adults don’t change much over time.)
Comments
This work by Leslie Kernisan MD & Better Health While Aging LLC is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at BetterHealthWhileAging.net.
The best thing I did this year was sign up for your site. I question all medical treatments and drugs. I am eighty six years old and in excellent health.Your information is so intelligent and complete on every subject you cover, I am impressed..Do I sound like a Fan? Yes I am. Thank you for all you do., and educating the public.
Thank you for this lovely feedback! I’m going to post a copy in my office 🙂
Good Morning my mother was told that her hemoglobin is 9.2 and her ferritin is a 6 she was diagnosed with non Hodgkins Lenphomia about 6 months ago and has been on Chemotherapy treatments every 28 days since July of this year and just finished her last treatment this December. She has always delt with anemia but her hemoglobin has never been this low. Could the chemo be a cause of her hemoglobin being so low? She is also on blood thinners for an irregular heartbeat has has been fixed but she is still on the blood thinner. She is currently taking iron infusions. I am hoping that all of this has caused her iron levels to get worse and not something else more serious. I would like your opinion.
Certain forms of chemotherapy can cause or worsen anemia, usually by interfering with the body’s ability to make new red blood cells. It is also possible for certain forms of cancer to contribute to iron deficiency, either by causing bleeding or by interfering with the body’s ability to absorb iron.
A ferritin of 6 sounds quite low and concerning for iron-deficiency. But in someone like your mom, it’s quite possible that she might have iron-deficiency and also other issues causing anemia.
I would recommend that you ask her doctors to explain what they think is causing her anemia. If they tell you it’s iron deficiency, ask them to explain why they think she is low on iron and do they think she might have had some bleeding. Being on blood thinners does increase one’s risk of bleeding. Good luck!
Hi! My mother is 61 years of age and her haemoglobin has fell from 12.8 to 10.7 in four months.she has heart palpitations and hair fall.
She is hypothyroid since a long time and it is controlled.
She has a mild gastroenteritis and always suffers from constipation.she is on medicine for her gastroenteritis for the last one month .she is on tegrital dose 200 mg thrice a day for trigeminal neuralgia.
She got a little cold since a few days.
What could be the cause of her low haemoglobin?. Also to mention her mch and mcv values are normal while hct is low.her RBc value is 3.55 and every other parameter in the CBC is within a normal range
I have listed the common causes of anemia and hemoglobin drops in the article. It’s impossible for me to say what is most likely in your mother’s situation. I would recommend you ask her health providers to explain what they think are the most likely possibilities. You may also want to ask if there are any signs of iron-deficiency or bleeding, since those are not uncommon in older adults. good luck!
Thank you!
I have low feritan stores and take one iron tablet a day because anymore gives me tummy pain and bloating. Whats the difference between low feritan and anemia? I am permanently tired still.
Anemia means low red blood cell count. The body needs iron to make red blood cells, so iron-deficiency is one of many possible causes for anemia.
A low ferritin usually means abnormally low iron stores in the body. This can be improved with iron supplements, but it’s important to work with the doctor to find out why you are low in iron in the first place.
Also, after starting treatment, be sure to ask the doctor about the follow-up plan. If you have been taking iron tablets, has your ferritin improved? Has your anemia improved?
Last but not least, it’s possible to have more than one cause for anemia, and fatigue can be caused by many different problems. So you need to keep going back to the doctor until you both are satisfied that you’ve figured out the health problems AND successfully treated them.
Please be sure to follow-up with your doctors soon. I recommend you ask about your latest lab results and make sure they know you are still feeling tired.
I have no energy at all and I am 80 years old. Send me a message if you can on my facebook. I use to be so energetic and never stopped getting every thing done and never sat down. Now all I do recently is sit or lay down. This is not my normal self.
Hm. Although it is common to feel a little less energetic as one gets older, to feel one has “no energy at all” is definitely not normal, especially if you’ve usually been an energetic person.
There are many many different health problems that can cause a person to feel they have no energy. I would strongly recommend that you contact your usual health provider, to get evaluated. They will ask you about other symptoms, they’ll do a physical exam, and then they will probably order blood work as well. You can learn more about common blood tests here: Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults
Hope you feel better and get some answers soon.
Hello! I was placed in the hospital for anemia (four years ago).
I was bleeding on the lining and have a hiatal hernia.
For six months I was exhausted.
Finally I decided to try a high dose of vitamin b12/b6/folic.with medication ferrous.
First day of B’s,I did notice a small amount of energy.
Second day feeling more energy.
Slept 12 hrs instead of 15.
I now sleep normal hours.
I taught handicap children who took vitamin b shots.Big differences in thinking and energy.
Hernia surgery repair in a few weeks.Have great hope!?
Yes, in some cases anemia may be due to vitamin B12 deficiency, and in this case, vitamin B supplementation helps a lot. I have more here:
How to Avoid Harm from Vitamin B12 Deficiency
Glad you are feeling better.
Great info here but a question my 88 yr old mom was just told her hemoglobin dropped 2 pts. They want to do colonoscopy or cat scan Do you think we should start there?
Two points is a fairly sizeable drop, so I’m glad they are investigating. It is indeed common for doctors to check for bleeding or some kind of abnormality in the colon. Colonoscopies and CAT scans are one way to do this. Often they will first check the stool for signs of microscopic blood loss.
I can’t say whether colonoscopy or CAT scan is the right place to start, because I can’t know enough about your mother’s situation. I would encourage you to ask more questions of your mother’s doctors. A colonoscopy is generally more invasive and burdensome than a CAT scan, but a colonoscopy offers the option of taking biopsies or sometimes removing polyps. If you are trying to decide what to do next, ask the doctors about the risks and potential benefits of each option. Also ask how the procedure is likely to benefit your mother.
Good luck!
My husband is 76 and was just diagnosed with iron deficiency anemia. All things that cause this loss of red blood cells, all of the digestive and intestinal scans have found nothing wrong. What else can cause this inability to absorb iron. He has to have infusions. Cannot handle any of the pills.
A true inability to absorb iron is usually related to problems with the bowel lining; there are several conditions that can cause this. A doctor specialized in gastroenterology or hematology will be able to provide you with more details.
However, a negative evaluation so far may not mean that your husband doesn’t have some type of blood loss somewhere…sometimes it takes a second evaluation or a different type of evaluation to discover the cause of microscopic blood loss. Here is an interesting article which seems relevant:
Outcome of endoscopy-negative iron deficiency anemia in patients above 65
Good luck!
My dad is 77 years old, had an angioplasty 5 years back, he is diabetic more than 3 decades, but always control. the last one to two-year his HB level is between 10. 5 g/dl -9.6 g/dl . no blood losses noticed, stool test also did. he is doing all his daily activities himself. Iron tablets are prescribed by the doctor along with all other medicine.
what could be the reason.
I would encourage you to ask your dad’s doctor more questions about the anemia. What has led the doctor to conclude that your father needs iron tablets? Was a ferritin level checked?
You can also ask the doctor to explain if anything other than iron deficiency might be contributing to the anemia. For instance, after decades of diabetes, many older people have developed some chronic kidney disease. This can cause some mild anemia.
Lastly, if your father has been treated for anemia but his anemia has not improved, then you can ask the doctor to discuss this and explain this to you. Good luck.
My mom is 88. Significant blood loss has her in hospital her hemaglobin was 5. She was given blood and iron’ endocopy and colonoscopy both negative. Still saying her iron is low. Hemaglobin at 7.7 for past 2 days. Still trying to figure out blood loss and iron deficiency. She is diabetic and has Afib. Yes she was taken off blood thinner
Yikes, a hemoglobin of 5 is really low.
As noted in one of the comments above, a negative evaluation so far may not mean that your mom doesn’t have some type of blood loss somewhere…sometimes it takes a second evaluation or a different type of evaluation to discover the cause of blood loss. Here is an interesting article which seems relevant:
Outcome of endoscopy-negative iron deficiency anemia in patients above 65.
I would recommend you ask the doctors to talk to you about what they think has caused her blood loss. Make sure you are clear on what their plan is for evaluation, and for monitoring to make sure the problem is improving. Good luck!
I’ve always had low hb (30) years New test was hb of 10.5 but ferritin 91ng with 38% saturation. New Doc wants me to take iron but it appears to me that ferritin is fine therefore it wouldn’t be an iron issue. Should I ask for more testing?
Hm. That’s not a very low ferritin level and usually transferrin saturation should be lower, for iron-deficiency anemia. However there may be particular factors related to your health that have caused your doctor to conclude you’d benefit from iron supplementation.
I would recommend you ask your doctor to explain his/her reasoning further. If you still have doubts after that, you can either try a trial of iron supplementation and see if it improves your anemia (you should see improvement within 1-2 months), or try getting a second opinion, perhaps from a hematologist.
Thank you for this very concise and informative posting on elder anemia. I am an almost 67 year old male Caucasian in reasonably good health. I do have high blood pressure long controlled by an ACE and I have had a CPAP unit for sleep apnea for 17 years. I have felt daily fatigue for over a decade. A recent CBC test showed that Mean Corpuscular Volume (MCV) is small. Is this likely multi-causal or even idiopathic? Should I be concerned about such a reading?
It’s hard to know what to think of a single CBC factor that is abnormal. Generally, it’s a good idea to look at past CBCs, to determine whether this is a long-standing abnormality versus something new or worsening.
The most common causes of microcytosis are iron deficiency and anemia of chronic inflammation. However there are some genetic conditions that can cause chronic small red blood cells, and there are many other less common causes for smaller red cells.
You can learn more about the evaluation of low MCV here: Evaluation of microcytosis.
Be sure to discuss your questions and concerns with your doctor.
Thank you for your thoughts on this matter. I will pursue it with my physician
My vagus nerve severed 9 years ago during surgery at Mayo Clinic for stomach being in chest and choking. Have had constant diarrhea leading to 3rd stage kidney failure. Now have trouble bing so tired and blood tests show ferritin level 585, iron 25, hemoglbin 10, but raised within 1 month to 12.5. TMy nephrologist said I have iron anemia and is giving me 900 mg iron daily. been doing this for 1 week now. Still very tired. Name of surgery was Paraesophageal. Please help. Grandmother had pernacious anemia. I also experience numbness in feet and my gait is off.
I would like help with all that I described. I would really appreciate what u would do. You are so nice and extremely knowledgeable. Thank you. Bettie Anton
Unfortunately, I don’t know much about vagus nerve injuries. At age 83 and with the health problems you describe, there are many reasons why you might be very tired. There are also many reasons why someone your age might feel their gait was off.
For numbness in the feet, we usually check for common causes of peripheral neuropathy, including checking vitamin B12 levels. (Low vitamin B12 causes pernicious anemia; learn more here: How to Avoid Harm from Vitamin B12 Deficiency)
I can’t say whether your labs are consistent with iron anemia or not, because iron metabolism is more complicated in people with significant kidney disease.
I would encourage you to talk to your primary care doctor and your nephrologist about your fatigue and other symptoms. Ask them to help evaluate you for other potential causes, or consider a second opinion from a hematologist or neurologist. Good luck!
My father is 87 and in a nursing home for over a year. His arthritis is severe. He is treated primarily with scheduled tylenol. Narcotics seem to cause hallucination. His hemoglobin has been low since his admission – around 10 – but has been dropping slowly since. He has been given iron daily. More recently, he was sleeping more, eating less, and seemed more confused. He was diagnosed with a bladder infection, a first for my father. He is taking antibiotics. His hemoglobin is just above 7 now. What tests should I insist upon?
Hm, this does sound concerning.
What you probably want to insist on is an explanation, rather than a particular test. A hemoglobin sliding down from 10 to 7 is not trivial. What do his doctors think is going on? If they aren’t sure, what is their plan for sorting it out? If they have a theory, what is their plan for treating or managing this?
The article lists common follow-up tests used to evaluate anemia, so you could certainly ask if those have been done.
Regarding your father’s recent symptoms, they are concerning but “non-specific,” which means they can easily be caused by a variety of illnesses and health problems.
By the way, urinary tract infections can be incorrectly diagnosed in older adults, for more on this issue, see here:
UTIs and Urine Bacteria in Aging: How to get the right diagnosis & avoid unneeded antibiotics
Good luck, I hope that you get some answers soon, and also that your father starts feeling better.
My 94 year old father is a nursing home resident with not much quality of life left. He has advance directives in place to prevent unnecessary procedures to prolong his life. I was told today by one of his nurses that they did some blood work and detected a hemoglobin level of 5.1. He has been tired and not eating well. What can I expect as his levels continue to drop without treatment? Currently he has no pain. Will this change?
A hemoglobin of 5.1 is pretty low. I would expect him to get increasingly tired, and also perhaps start experiencing some shortness of breath. A low hemoglobin level also puts some strain on the heart and other organs. He could start experiencing some angina, and he could at some point experience a cardiac arrest. With low oxygen levels in the brain, he might also be drowsy or confused.
If he is 94 and the goal is to keep him comfortable and not prolong his life, then you may want to consider hospice care. A hospice team may be better able to manage any symptoms, and will also be equipped to answer your questions and provide you with support, as you help your father navigate this last stage of life. Good luck!
My aunt will 88 next month. Over the past year she has had episode of blacking out and falling. The latest incident happened at the top of her basement stairs. She blavked out and tumbled to the bottom. She then made her way upstairs. Het son took her to emergency. They said her blood level was low and 2 liters. It is still low. We need help. They also diagnosed a bladder infection
Sorry to hear about your aunt’s difficulties.
Yes, I agree that you need more help. You will need to keep asking a lot of questions of the doctors. How low is her red blood cell level? How fast did it drop? What do they think caused it? What are they planning to do to investigate further, or to treat this?
You don’t say how low her blood count was, but if it’s low enough, it can certainly lead to passing out, and falls. However there are many other problems that can lead to this. So, you may want to ask more questions to make sure those symptoms have been properly investigated. In particular, low blood pressure can also cause blacking out and falling.
Good luck!
My mother is 90 yrs old, she lives in a residential care home. She neglected her diabetes for many years without dealing with it, eating and drinking anything she liked. Now she is on insulin and has chronic kidney disease, She has had many blood transfusions and still the blood is very low – 5. with anemia. She has been in hospital every month for transfusions after blood analysis showed it low can you tell me why the blood is so low and for a long period of time now. Kind regards Laraine White
A hemoglobin level of 5 is indeed quite low, probably too low to be caused just by chronic kidney disease and/or anemia of chronic disease.
It’s impossible for me to say why it’s so low. You will need to keep asking her doctors questions. Why do they think it’s so low? What is their plan for figuring out the cause, or at least helping her sustain a better hemoglobin level? What do they think you and your mother should expect over the next few months?
Good luck!
My dad is 71 years old Afican American with Renal Failure, HBP, Diabetes(insulin), high cholesterol and he has anemia. He just had a heart attack and a bad stroke in June 2017. His hemoglobin levels dropped from 10 to 7 about 2 weeks ago. They did a cult and found small amounts of blood. I called today his levels were 11.3 on 8/17/17. He has an appointment tomorrow to see if he need a colonoscopy. He is very weak, not eating a lot, he has a knots popping up in his head and in his lower back. In May he just had a cyst that kept filling up with fluid removed off his back in which it healed slowly. My dad is getting light in skin color or a pale look, he is also somewhat disoriented. I am very concerned.
Wow, sounds like your poor dad has had a rough time with his health these past few months.
His confusion might be delirium, you can learn more here: Hospital Delirium: What to Know and Do
I assume you are referring to a “hemoccult” test, which is when they put a smear of poop on a special card, which allows them to check for microscopic blood in the stool.
If he had a heart attack and a stroke, then he may have been put on medication to prevent further blood clots, such as Plavix and/or aspirin. Such medications do reduce the risk of another cardiovascular event, but they also come with a risk of bleeding; that type of medicine could contribute to or cause a bleeding episode such as what you describe. But at his age, it’s also possible to have all kinds of problems in the stomach or bowel that can cause bleeding; a colonoscopy would check for some of those.
I would encourage you to keep asking a lot of questions, as his situation does sound concerning. You may want to ask what is his hemoglobin level now; normally someone would not look very pale with a hemoglobin of 11.3. Good luck!
My 97 year old Mother was just hospitalized this past weekend with a hemoglobin count of 6.3 . . .in February of this year her count was 10.7 . . .they did a routine blood check and found the low count . . .they gave her 2 units of blood that brought her count to 11.2 . . .and sent her back to the home . . .they also used Protonix for the bleeding . . .they talked colonoscopy and scoping her throat but the gastronenterologist said both were too risky for her at her age and we agreed. Her blood pressure was very high 198/90 so they put her back on her blood pressure medicine which she has been off for almost a year because her pressure was so low . . they are going to monitor her BP each month and said if the count drops again to bring her back to the Hospital and they will give her blood and fluids again and continue to treat her that way and any invasive tests are out per her Health Care Directive . . .Even though they don’t know what’s causing the bleed is using Protonix good for her . . .it is a pph and that worries me . . .
The proton pump inhibitor Protonix is routinely used to reduce the chance of rebleeding, but that only works if the bleeding is coming from the upper part of the gastrointestinal tract (e.g. the stomach or the beginning of the small intestine). A PPI does not help if one suspects bleeding from the colon.
Normally the doctors have some idea of whether the bleeding is more likely to be from the upper part of the GI tract versus the lower part. I would encourage you to ask them which one they suspect. It’s not ideal for an older adult to be on a PPI long-term unless it’s really necessary, but it’s also unlikely to harm her over the next 6-12 months, the recent concerns over PPIs are more about people taking them for years and years.
It’s probably most useful for you to focus on helping the doctors monitor her BP and her blood count. After a significant drop, it’s often a good idea to check the count again after a week or so, to make sure it is holding steady. It should also be possible to check her blood pressure at least every few days in the beginning, to make sure she is not too high or too low with the current dose of BP meds. Good luck!
Hi
My mother in law who is 79 years old was diagnosed with atrial fibrillation 4 months ago. Since then her iron levels have dropped and she is anemic. is there a correlation between AF and anemia?
Atrial fibrillation on its own does not cause anemia. However, atrial fibrillation does cause a significant risk of stroke, because when the heart fibrillates it’s much easier for the blood to create a clot; if that clot then travels to the brain, you can have a stroke.
To reduce this risk of stroke, most people with atrial fibrillation are put on a blood thinning medication. Those ARE associated with a risk of internal bleeding, which can cause anemia.
Hi, my mother is 74 and has marginal zone lymphoma(she’s currently on watch and wait and has been for a number of years). Her Hematologist has said she is iron deficient(her level was 10) and has given her an iron infusion, but has also referred her to a Gastroenterologist. She has had 2 ct scans and an ultrasound and aside from a Splenomegaly,they were clear. My concerns are for colorectal cancer, although she feels fine ,has no blood in her faeces or stomach pains etc. My mother has also been on Warfarn for 30 years and self tests her own inr. Could the warfarin be responsible for a slow bleed that she would be unaware of? Thanks in advance:)
Warfarin requires careful monitoring of a blood thinning metric called “INR.” Usually the goal is to dose warfarin so that a person’s INR remains between 2 and 3.
If your mom’s INR has usually been in the right range, it would be unusual for this by itself to cause a slow bleed.
Your mother is currently seeing the right specialists to address your concerns. I would encourage you to ask them to clarify why they think she is anemic and iron-deficient. The gastroenterologist should also be able to address your concern about whether she might have colo-rectal cancer, despite her so-far reassuring test results.
Hi,
My mother’s inr has been above 2 /3. It has been as high as 6, but mostly around the 4 range. So I’m guessing this puts her at greater risk of a bleed then?
Her inr has become more unstable this year and she seen an increase in bleeds into her eye and bruising.
Thank you for your help
Yes, the higher the INR, the greater the risk of bleeding.
An unstable or frequently high INR sounds concerning. I would encourage you to bring it up with her doctors, especially the one who prescribes her warfarin or who initially recommended she be on it. (Many people take warfarin related to a heart condition, but the prescription is often written by the PCP.)
Warfarin is one of the top drugs for causing ER visits, hospitalizations, and complications, mainly because it can be a challenge to keep people within the safe range.
You might want to ask whether it might be possible to switch her to one of the newer blood thinning agents, such as dabigatran or apixaban (Pradaxa or Eliquis). These newer medications do not fluctuate in the body the way warfarin can, so these can be a safer choice for some older people. So far their safety track record seems acceptable, and recently an “antidote” to dabigatran was approved by the FDA.
If your mom is having bleeds in her eye and bruising, then I think it’s definitely important to discuss her anticoagulation with her doctors. It should be possible to reduce her bleeding risk, either by helping her better manage her INR levels or by switching to a different anticoagulant. Good luck!
Well eat lots of beetroot it is really helpful …. thanks for sharing
Hi. Your website very helpful. 1 weeks ago, my internist told me I have anemia. Score was
10. I am 72 and in good health otherwise. He started me on iron – 2 per day. This past week has been very very difficult. I have weakness and fatigue. I have 2 questions. First, how long does it take to start feeling better after taking iron. Second, since my CBC was taken about 2 weeks ago, should I get another CBC to see how I’m doing.
Thank you for your kind help
I would encourage you to contact your doctors as soon as possible, and let them know you are feeling weak and doing worse than before.
When a person feels worse after being diagnosed with anemia, it’s usually reasonable to repeat the CBC within 1-2 weeks, to make sure the red blood cell count hasn’t dropped further.
Also be sure that your doctors explain to you why they think you have lost blood or otherwise become iron deficient. Don’t forget that it’s common for older adult to experience more than one cause of anemia at the same time.
Once the cause of blood loss has been fixed, then if anemia is due to iron-deficiency, the blood count should improve within 1-2 months. Good luck!
Hi,
My father is 56. He has hemoglobin level of 10.2 and is low on iron levels. His RBC count is a bit higher than normal range. Doctor gave him 1100mg iron drip 2 weeks back. His Hemoglobin level is still 10.2. what is the normal time after which we should take test again. what can be futher course of action.
Regards,
Charu
I don’t have any personal experience administering IV iron, but according to the related topic in Uptodate:
“There is no evidence that total doses above 1000 mg of elemental iron are clinically useful. We often give a fixed dose of approximately 1000 mg, which is generally sufficient to treat anemia (typical red blood cell iron deficit between 500 and 1000 mg) and provide additional storage iron without causing iron overload.”
Also, apparently IV iron interferes with most tests related to iron studies, so iron levels are not repeated during the month after administration of IV iron.
Usually, the hemoglobin level starts to slowly improve after 1-2 weeks, and one should see substantial improvement after one month.
I would encourage you to ask your father’s doctors to clarify what testing should be done, to make sure that his anemia has been sufficiently diagnosed and treated.
Sir I’m eating slate pencils for 2 years back till I’m suffering from blood loss. What medicine should I prefer? Is it danger to eat plenty?
Eating slate pencils sounds like a condition called pica, which means craving and consuming non-food items. Pica is associated with iron-deficiency anemia and other micronutrient deficiencies. It is unclear how often pica might cause deficiencies versus it being more a symptom caused the deficiencies. You can learn more here:
A meta-analysis of pica and micronutrient status
If you have anemia or blood loss, you need a thorough evaluation as described in the article, to determine what is the most likely cause of your low red blood cell count. It is impossible to know which medication or treatment is suitable until the underlying problem has been correctly diagnosed. Be sure to mention to your doctors that you have been eating slate pencils.
Namaste!
My mom is 65. The doctor told us she has severe Anemia. She refuses to eat anything. Also she caughs a lot nowadays. She has lost all of her weight and is always exhausted. The doctor checked her blood reports and prescribed some tablets but she isn’t recovering. She says she doesn’t feel hungry.
Is that normal? I mean if she doesn’t eat at all how will she get well? I don’t know what to do
Severe anemia can leave a person feeling exhausted, but by itself, it shouldn’t cause severe weight loss. It sounds like your mother has lost her appetite for some reason. If someone has such symptoms plus coughing, normally we would investigate for serious underlying illnesses, especially those in the chest or lungs. Usually the first step is a chest xray, and then possibly a CT. This can help rule out problems such as tuberculosis and certain cancers. (Please note that I am not saying that she has a serious condition such as this, only that the symptoms you describe usually warrant some preliminary testing to check for such serious conditions.)
Be sure to ask your doctor what tests were done and which findings, other than low hemoglobin, were abnormal. It’s best to get copies of the results, whenever possible.
In order to help your mother get better, you will first need to learn more about what is causing her symptoms. Generally the best way to do this is to ask her doctors lots of questions and also keep doing your own research.
I do have an article on unintentional weight loss in older adults, see here:
What to Do About Unintentional Weight Loss
Good luck!
My mom is 94 and in a nursing home. She was recently diagnosed with pneumonia. They also found she is severely anemic with her H&H going as low as 3.2 and 12. They have been giving her iron 4 x a day and today’s lab was 4 and 15. They are also treating her with antibiotics for the pneumonia. She has vomited several times after taking meds. When she is not sleeping, she is often agitated and confused. I want her to be comfortable but do not want to prolong her life. Is there a reason I should continue the iron supplements?
Yikes, that is pretty severe anemia. In my experience, if anemia is that profound and the goal is to try to extend life, then one needs to pursue a transfusion in the short-term. That’s because it just takes too long (weeks, at a minimum) for iron supplements to bring the hemoglobin back up. And that would be assuming that iron-deficiency is the main cause of the anemia and that the blood loss has stopped, which is often NOT the case for people like your mom.
However, if the goal for your mother is to keep her comfortable, then all that iron supplementation is unlikely to do that; it may well be contributing to her vomiting.
So, I would strongly encourage you to talk to your mother’s doctors about the “big picture” of her health and the goals of the medical care. Given her age and profound anemia, she is probably eligible for hospice care, and that is an excellent way to get medical care that focuses on comfort and managing symptoms, rather than trying against the odds to keep a person alive.
This article on hospice and dementia starts by covering basics of hospice, whether or not someone has a dementia diagnosis: Hospice in Dementia, Medications, & What to Do If You’re Concerned
You are absolutely doing the right thing in questioning what they are doing and researching other options. Keep going and good luck!
Hello mam I have haemogolobin 5.4 this month…..I gone through blood transfusion and then my haemogolobin is 9.6…..I start to take iron pills on recommendation of doctor and eating more fruits and green vegetables. Now my haemogolobin 4 days ago is 11.2…….I have bad habit of not eating…..I don’t eat food properly almost 2-3 months and eat mostly junk foods or eat only two time in a day………doctor can’t find out the reasons…I have hair loss also can you tell me the reason of this deficiency
Sorry that you have been having these health difficulties, but good that your hemoglobin is much improved.
I can’t suggest any reasons for what you describe, it’s just not possible online. If your doctor is unable to find a reason, you may want to get a second opinion. Especially when it comes to difficult cases or unusual symptoms, it’s essential to work closely with one or more doctors in person. Good luck.
My mom is 72 years old and has been receiving blood (transfusion) on a monthly basis since May 2017 due to anemia. On top of this, she receives weekly injection of epokine (1000 units). Her CBC tests have shown low levels of hemoglobin, hematocrit, and RBC index (MCHC); her lowest hemoglobin level was about 60 g/liter. It is exhausting for her; she is experiencing shortness of breath and fatigue. Her doctor has been recommending bone marrow test but my mom is so weak to undergo such invasive procedure. Just recently, we had her examine by a new doctor; stool exam was done and results show:
fecal occult blood – negative
h. pylori – negative
transferrin – negative
I hate to think that we will result in getting her undergo a bone marrow test; is there any other tests we can do first? What we notice too that in the last two months, we needed to have her blood transfusion done earlier (less than one month interval).
It sounds like the doctors think your mother’s anemia may be related to a problem with her bone marrow or her production of blood cells. A bone marrow biopsy is an important test, because it will provide a lot of information on what might be going wrong.
Usually, before doing a bone marrow biopsy, the doctors will order a review of the “peripheral smear.” This is a test in which the cells in the blood are examined on a slide. A bone marrow biopsy is usually recommended after a peripheral smear suggests that there is a bone marrow problem.
Bone marrow biopsies can hurt, but it’s not as invasive or tiring as having an operation. Your mother sounds like she is experiencing a lot of symptoms from her anemia. So it’s important to proceed with the evaluation, because successful treatment depends on first getting a correct diagnosis. Good luck!
Dr Kernisan,
I appreciate you taking the time to answer my question.
She just had another blood transfusion and we requested to get her ferritin test done early this week. We got an approval for this test but we are wondering if the recent blood transfusion may interfere with result of the ferritin test.
More power to you and thank you very much for running this website. It is indeed an excellent website.
kind regards
BT
According to this study, transfusion does not quickly change levels of ferritin, vitamin B12, or folate:
The effects of blood transfusion on serum ferritin, folic acid, and cobalamin levels
My friend,60 year old female was treated for severe anemia for over 18 months during which time they tried iron suppliments,checked for bleeding and gave her monthly infusions because the hemoglobin was usually down to 5-6. There had been times when she passed out and had to be transported by ambulance to the ER where they gave her blood and discharged her.
At no time did they do a bone marrow biopsy or check for cell destruction/production rates.
Finally she changed doctors.
A month later she was admitted to the hospital with a 2.8 hemoglobin level.
Upon discharge the new doctor did a biopsy and discovered she had over 50% blasts and hemoglobin was at 7. He immediately sent her to a cancer center She had a round of traditional 7 + 3 chemo and after the blastes were down to 5%,however,two week later a biopsy revealed 30% blasts. The AML was resistant to chemo because of an invered #3 chromsone. She is now receiving alternate less strength chemo.
Should not a bone marrow biopsy or reticulocyte count have been down at the very beginning ? Why go almost 2 years with infusions instead of determining the reason for the low hemoglobin levels ? And to top it off the original treatment was with another cancer center.
Yikes. I’m sorry it took them so long to figure out what was going on.
Yes, it’s important to do a careful evaluation at the beginning, to determine whether the problem seems to be losing blood versus a problem making red blood cells, which can be due to a bone marrow problem or malignancy.
Hard to say whether they should’ve done a reticulocyte count and peripheral smear at the very very beginning, but I am surprised they went on treating presumed iron-deficiency for such a long time…
I wish her the best with her AML treatment, I’m sorry they didn’t catch it sooner.
My mum diagnosed with myeloma last November. She has had two bone marrow biopsies and skelaton xray. Paraprotein of 3% . No chemo as mum still able to do homebaking herself but had first blood transfusion when her reading dropped to 8.7. She is fine but they seem to be pushing her to go unto Aranesp 500mg injections which we as family after researching think is not great option. She has had Mini stroke shortness of breath clots etc in past and think tranfusions would be safer option. Thank you.
Sorry to hear that your mother has been diagnosed with myeloma.
I really can’t venture an opinion as to how she should be treated. It sounds like you are researching options, which is exactly the right thing to do. I would recommend searching very high-quality sources of information on myeloma treatment, such as review articles in reputable journals. A second opinion from a doctor specialized in blood cell cancers may also help. Good luck!
Dr. Kernisan,
Great post for us elder people who suffer from anemia.
In 2015, I came down with a crash! With > 4 ferritin and 4 iron, I had blood perfusion ordered in the clinic as an emergency. I didn’t feel good after the perfusion and the second was half the regular amount. After that, a long painful uptake with a strict diet and spirullin kept me fatigued, depressed with skin outbreaks, hair loss, and general weakness for over two years.
In 2017, I started slowly to get better, with 20 ferritin, 24 iron but only 10.6 hemoglobin today, I feel much better. That’s pretty good after the ordeal. I am still taking ‘Gynotardiferon’ often prescribed in Europe for elder persons.
An anemic person should give up coffee, black tea, alcohol, and preferably stick to a dissociated diet. And outdoor activities pumps the lungs and strengthens mind and body.
Right Doctor?
When older, it is harder to recover from anemia. Diet is crucial.
Thanks for sharing this information.
Greetings
Thank you for sharing your story, I’m glad you are feeling better.
Dietary changes to treat anemia really depend on what caused the anemia in the first place. I am not aware of any studies indicating that people with anemia should give up caffeine or alcohol. Per the Mayo Clinic website, iron supplements are best absorbed on an empty stomach but may be taken with food in order to reduce stomach upset. The best, of course, is to confer with one’s own doctor and pharmacist regarding all of this.
Outdoor activity and exercise is indeed very good for the mind and spirit.
Dr. Kernisan,
I received iron transfusion not blood transfusion. I don’t know in which cases blood transfusion would be given to patients for anemia.
Best regards
Gwen
Blood transfusions are given when a person’s hemoglobin is dangerously low. A transfusion will raise the hemoglobin quickly, whereas treating iron-deficiency or other underlying causes of anemia often takes weeks.
A transfusion is only a temporary fix, however. So it’s always essential for patients and families to be sure the doctors have explained why the anemia happened in the first place.
My haemogolobin was 5.4… And had to be admitted I got blood transfusion and then haemogolobin raised to 9.6 also in my lft report my bilirubin was 2.3 sgpt=480 and sgot =460…after taking iron pills 10 days and good diet HB=11.2 then I stop taking iron pills after 1 week my HB was 13.5 and sgpt=124 and sgot=70……….I really don’t know but I am 20 yrs old…..my bad habit was I am vegetarian eat no meat and eggs…..and I had to admitted that I don’t used to eat green vegetables…. And used to eat fried and spicy foods????? Can nutritional deficiency can be a reason?????
You should ask your doctors to clarify why they think you became anemic, so that you can avoid recurrence of your anemia.
Meat does contain iron and also vitamin B12. Both of these are necessary to make red blood cells. If you plan to remain vegetarian, be sure to ask your doctors to help you identify other ways to get these nutrients. You may need to take iron supplementation indefinitely, if you have no dietary source of iron. If you are a vegetarian who doesn’t eat many vegetables and eats a lot of fried foods and carbs, you may also be at risk for other nutritional deficiencies. Good luck!
I became anemic twice when I was a vegetarian, although with a better diet than Rajat. The first time my mother was overdosing us on zinc supplements, which binds with all heavy metals including iron. Thought it was lead poisoning from bicycling in heavy traffic, (in the 70’s when gas was still leaded. blue fingernails and lethargy were symptoms. Learned about zinc issue from reading further than Prevention magazine. went away when I stopped those supplements. I didn’t do iron supplements, which are usually inferior iron compound and not absorbable as food sources. The second time was in Germany after a winter of drinking retsina in Greece in 1980. The naturopathic doctor in Germany recommended steamed stinging nettles, richest plant source of iron. Pick them with gloves, from an isolated location, or buy dried. Rapid improvement.
Thanks for sharing your story. In most people, oral iron supplements are an effective way to treat iron deficiency. However, certain foods interfere with iron absorption and medications that interfere with stomach acidity may also reduce absorption. It is also very common for people to experience unpleasant gastrointestinal side-effects from iron supplements. Generally, the higher the dose of elemental iron in the supplement, the more likely people are to experience side-effects.
Plants do contain iron but it is non-heme iron, which is actually less well absorbed by the body than the heme iron which is in meat.
A key to treating any type of iron deficiency is to check on how well the treatment is working, within a few weeks. If a person is able to raise or maintain their iron levels with a certain dietary approach, then additional iron supplementation may not be necessary.
This is a follow-up query on the case referred by Ms. Elaisa Tubana (I am her aunt) about my mother, 72 yrs old, who is suffering from anemia, and requires blood transfusion almost twice a month(recently) and a weekly injection of epokine. We would like to know if its a must to have eight common follow-up test you mentioned above prior to bone marrow test. Accordingly, my mother do not have ferritin test yet. She only have so far the CBC which yield result on reticulocyte. Is it similar to peripheral smear. My mother will be having another blood transfusion this coming October 7 , including epokine injection. Likewise, the doctor is advising her to have the bone marrow test after the blood transfusion.
Kindly enlighten us on this. We need direction of whether we will proceed with the bone marrow test or have these 8 common follow-up tests first. Thank you and God bless.
Sorry but I can’t say which tests should be done for your mother’s situation. I do list eight tests that are often done, but whether or not to do them depends on the specifics of a patient’s health situation, and on the doctor’s clinical judgment. I will say that in the U.S. it would be extremely unusual to do a bone marrow biopsy without first reviewing a peripheral smear. A bone marrow biopsy is usually done after other tests have suggested a problem in the bone marrow. Your mother’s doctor should be able to explain why it is that they suspect a problem in her bone marrow.
I can’t provide more specific guidance or make recommendations online. The purpose of this site is to provide information and education only, to help people ask better questions of their health providers.
You could certainly ask your mother’s doctors about the tests mentioned in the article, and whether it would help to do those prior to proceeding with a bone marrow biopsy. Otherwise, for more specific direction, you would need to get a second opinion from a doctor who can work with your family in person, to examine your mother and review her test results so far. Good luck!
My mother is 83 years old.She was dignosed with urinary tract infection.Her HGB level was 7.4.She was treated and after treatment of UTI her HGB is 9.4.Does She need to improve HGB with injecting venofer? or her HGB will improve naturally with the passage of time?
A urinary tract infection, in of itself, does not generally cause anemia, and usually treating a UTI does not, in of itself, cure anemia or raise the hemoglobin level.
Venofer is an iron infusion. It’s impossible to say whether that might be a reasonable treatment for a person’s anemia, without first investigating and identifying the underlying cause of the anemia.
Similarly, whether the hemoglobin will improve on its own depends on why it went down in the first place. If the problem was a bleed and the bleeding is stopped and the person has a well-functioning bone marrow and adequate iron stores, the body will eventually correct the anemia on its own. However, many older adults have chronic medical conditions that can impair the body’s ability to recover from anemia without assistance.
I would recommend you ask the doctors more questions about what they think caused your mother’s anemia, and why it has improved. Good luck.
87 year old mother in long term care. Last stage of Alzheimer, confined to wheelchair.
Has had CLL for over 30 years, but no tx, just monitoring.
Three days ago, severe bruising appeared between morning and bedtime. Her right shoulder and chest were purple and the bruising progressed down her arm. Staff don’t know what happened.
CBC done…..WBC 18.6, RBC 2.2, Hmg 70.
GP at facility feels severe bruising attributed to Hmg, but I am concerned about “rough handling”.
Can bruises appear spontaneously?
Your article is very informative and I have copied the questions to ask about her anemia with the facility doctor.
I’m not sure if we should have her assessed outside the facility, DNR is in place and she has absolutely no quality of life anymore.
Yes, it is possible for bruises to appear spontaneously. One potential cause is developing a low platelet count, which can happen with certain illnesses or serious conditions.
Older adults also tend to bruise more easily than younger people, for a variety of reasons.
The Mayo Clinic has a good article on bruising in late life here: Easy bruising: Why does it happen
If she is becoming more anemic and has late-stage Alzheimer’s, you may want to consider hospice. This often improves the quality of care for people with severe Alzheimer’s, and they will help address any pain or other symptoms she might be experiencing. They will also provide some support for you. You can learn more about hospice for dementia here:
Hospice in Dementia, Medications, & What to Do If You’re Concerned
Good luck!
My mother (age 64 years) has HB level 8.0 in her report. The doctor did not do any other test (and as per my mother he did not do physical examination either, just asked her questions regarding sleep and fatigue) and prescribed her the following 2 medicines – Pevesca Plus 75 Tablet SR and Vintor 4000 IU injection – and asked her to come back to visit him if after completion of the course of these 2 drugs (1 month period) her HB levels still don’t increase.
When we went to a nearby doctor’s clinic to inject this injection in her body, they refused to do it saying that the injection (Vintor 4000 IU ) is known to have reactions and is potentially dangerous and we must get this injected from some hospital.
Now we are worried whether we should go ahead with this injection or not (with the 2nd doctor telling this is a risky injection). I googled up what cause of anemia is treated using this injection and it looks like this is when kidney is not producing some required hormone related to red cell production, when person has some kidney related disease. My mother never had any kidney disease and I suspect the doctor just prescribed the drugs based on 2 most common causes of anemia in elderly people.
My mother is a diabetes patient and takes medicines for diabetes, blood pressure and thyroid in routine. Doctor 1 who prescribed her medications is aware of her medical history and all the earlier medicines for these things have also been prescribed by him.
Can sometime tell me about the potential risks of this this injection(Vintor 4000 IU) and how risky it can be in worst case ? Can my mother try some other things or tests to treat her low HB levels and get rid of the fatigue and tiredness she experiences daily ? (Her fatigue is not that she can’t stand and stuff, just that she gets tired doing household work, so it is difficult to say how much is due to low HB levels and how much is just due to her age.)
Which test can be done to determine conclusively if her anemia is of the type which actually needs this Vintor 4000 IU injection or its variant for the cure/management ?
Is is possible to get the HB level improved or back to normal through natural things like diet and may be (mild) and relatively harmless supplements only ? even though this process may take longer time
The brand names you describe are not used in the US. It looks like Pevesca is alpha-linoic acid, which is an antioxidant sometimes used to treat diabetic neuropathy. You can ask the prescribing doctor if this is meant to treat anemia or some other problem your mother may be experiencing.
As for Vintor, seems this is erythropoietin. As I explain in the article, erythropoietin (“epo”) is made by the kidneys and helps stimulate red blood cell production. People who develop chronic kidney disease may have lower than normal epo levels, which can cause or worsen anemia.
In the US, epo is mainly used to treat anemia that is associated with chronic kidney disease, or otherwise seems to be related to low levels of epo. It is possible to test blood levels of epo, but usually this is only considered if the person already shows signs of a condition associated with low epo.
I would recommend that your family ask the doctor more questions about what might be causing your mother’s anemia. This will help you understand whether treatment with epo is likely to help, and you can ask about the associated risks at that time.
Many people with diabetes do develop some chronic kidney disease, so you should confirm your mother shows no signs of that on her labs. Chronic kidney disease is usually associated with higher than normal creatinine and blood urea nitrogen, and also lower than normal glomerular filtration rates. (See Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults for more information.)
Until you learn more about what might be the underlying cause of your mother’s anemia, it is impossible to know what treatment, whether natural or prescription, is likely to resolve your mother’s anemia. Good luck!
Thank you for sharing your knowledge.
The doctor asked my mother that she must take the prescribed injection Vintor 4000 which you rightly mentioned is synthetic erythropoietin (“epo”), if she wants to try coming out of her lethargic situation where she keeps getting tired all the time.
My mother has today taken 3rd of the 4 weekly injections prescribed. The doctor had asked her to come to him after 6 weeks and after this “epo” prescription course is completed. She is complaining that she is feeling even more tiredness than earlier after taking these injections so far. So tomorrow we will get her HP count checked from lab.
Can you tell usually how much time does it take for erythropoietin (“epo”) to show its effect and increase production of red blood cells ?
I am not a hematologist or kidney doctor, so I don’t prescribe or administer this type of medication. The doctor prescribing her erythropoietin would be better qualified to answer your question.
The bone marrow usually takes about a week to create new blood cells, so presumably one should see some effect of this type of medication within a few weeks.
Again, what is probably most important is for you to ask lots of questions of the treating doctors, so that you understand what they think is the underlying problem and what they are planning to do next, especially if her hemoglobin doesn’t improve or if she continues to have symptoms.
Just a quick note to thank you for offering this excellent website to all of us that are “in the dark” about so many health problems!! Absolutely, by far, you are the best!! You sure have a way of explaining things that seems to get through to these “old, slow brain cells!!” 🙂 Thanks, again!!!
Thank you for this comment. So glad you are finding this helpful. I would love for people to feel less “in the dark”!
Can you review the bed bug article(s) and comment? A third unexplained in wake of current epidemic is outrageous, the insects have the ability to impact platelet count.
Would you support an evidenced based policy for reporting? I think this is an exception, privacy rights need strengthening and subsidy for poor is sufficient incentive for self reporting, if privacy is respected!
Watch youtube for scandalous cell phone video by ‘ exterminators’ that include spraying poison in front of occupant shown being mocked, his blood pouring out of bed a stream of red from poop of parasistes flushed by ‘pyrethin’ etc. sprayer!
The elderly need fear societal only justified extravigant costs financed wrongly by there personal life savings, and need to know there beds can be safe from excesssive blood loss with only encasements and frequent sheet and blanket ‘baking’ plus soon safer solutions to eliminate otherwise sustaining population.
State medicaid could save so much if they intervened early. I have met a lady who broke her back fallijg out of bed, and believe it was bugs that had her dauhter witlessly spend ten grand on lawyer to liquidate and sti ck her into semiprivate hell forever. The daughter confessed infestation etc. If excessive lab draws can effect CBC then thousands of animals sure can, and maybe costing golden decades
There are case reports of bed bugs causing anemia in older adults, one such report is here:
Bed bugs reproductive life cycle in the clothes of a patient suffering from Alzheimer’s disease results in iron deficiency anemia
There are also reports of anemia related to severe cases of head lice or body lice.
It’s certainly important to bring up any rash or itching, when being evaluated for anemia. It’s not really known how common it is for insects to be involved in anemia, but worth considering, especially if there are other reasons to be concerned about such insects.
Dear Leslie Kernisan,
I am 50 years old and I am an Asian Chinese male.
I have been doing my annual medical blood test for the past 5 years.
Over the past 5 years, I have been monitoring my Total White Cell Count (TWC) and I realized it has been on the decline.
Although it is still within the healthy range as told by my doctor, which is 4-11, I am a bit worried.
Here are the figures for the TWC.
Year Range
2013 – 5.9
2014 – 5.0
2015 – 4.6
2016 – 4.3
2017 – 4.0
MY Neutrophils and Lymphocytes are on steady decline, but my Eosinophils are slightly increase.
My doctor said there is no need to worry because the overall index is still within the healthy range.
My red blood cell counts are quite steady.
The medical report did not said I have any infections or cancers.
I have the following questions.
1. As I grow older, does that mean my overall white blood cells will decline? is this normal and what can i do to reverse the decline?
2. I know Vitamins B12 is good for red blood cells count. How about white blood cells?
What are the food to take fo increase my white blood cells, in pariicular Neutropjils and Lymphocytes?
Appreciate your advice,
Thank you very much..
Generally, the medical textbooks say things like “Total circulating white cells counts do not change with age in healthy older people, but the function of several cell types is reduced.” That said, this study noted a downward in WBC over time, but also found that higher WBC counts were associated with worse health outcomes. (Presumably this is because higher WBC counts can correspond to inflammation.)
White Blood Cell Count and Mortality in the Baltimore Longitudinal Study of Aging
The aging of the immune system is called “immunosenescence.” Researchers are currently working to piece together exactly how it happens, and how we might be able to influence this process.
Causes, consequences, and reversal of immune system aging
I don’t think anyone knows for sure how to counter or delay immunosenescence. Presumably exercise, enough sleep, a healthy diet, social relationships, and all the other things we know are good for older people can help maintain the immune system. But we don’t yet know of specific regimens proven to work.
Regarding vitamin B12, if you have concerns about deficiency then I recommend talking to your doctor about whether it might be possible to have your level checked. Studies generally find that as long as the body’s vitamin B12 levels are adequate, there’s no particular benefit to taking extra B12. However many older adults are low or borderline, so it’s often reasonable to check for deficiency. I have more here:
How to Avoid Harm from Vitamin B12 Deficiency
Good luck!
Dear Leslie Kernisan,
I will continue to monitor closely my TWC and the proportion of each different type of white blood cells in the sample for the coming years.
Thank you for the advice given!
Age:57, Gender: Male
Haemoglobin 3.9
Haematocrit 17.3
MCV 52.7
MCH 11.9
MCHC 22.5
RBC 3.28
PLATELET COUNT 535
Height (ft) 6 and Weight (Kg) 90
What is the reason do you think?
It is impossible for me to say what might be causing this anemia, there are too many possibilities and it is foolish to hazard a guess without more information as to the person’s medical history, symptoms, and physical exam findings.
I will say that a hemoglobin of 4 is very very low, and in most cases such a low level prompts immediate transfusion.
Dear Leslie Kernisan,
My mum is 73 years old.
She did an endoscopy in 2012 and was found to have fundic gland polyp.
However, it was biopsied and the the doctor said it was benign.
She also has gastroesophageal reflux disease (GERD).
Therefore, she has to take omeprazole pills, about 2 or 3 times per day for few years since 2012.
Each tablet is about 20 mg.
The medicine was prescribed by the doctor.
Once she stop taking or skip the pills for few days, she will develop symptoms like heartburn and her heart beat very fast
She also feel sensation of ‘heat’ in her stomach.
She did a blood sample and stool sample test recently and the results show it is normal.
But the doctor said she must continue to take the medicine on a regular basis and she shouldn’t stop.
I have the following questions.
1.She like to eat chicken or pig liver.
Is it bad for the patient with the above disease?
2. She is also taking Omega-3 fish oil supplement pills (over the counter), 2 tablets a day.
Each tablet is about 500 mg.
Is it OK?
3. Is taking too much sodium or salt bad for patient diagnosed with the above illness?
Appreciate your advice, thanks in advance.
This article is about anemia, not GERD. I would recommend that you address your questions to your mother’s gastroenterologist or generalist doctor.
You will be able to ask better questions about your mother’s original diagnosis and the options for management if you first learn more about GERD. Here is one article that looks reputable:
GERD: Diagnosing and treating the burn
Some people do need to take proton-pump inhibitors (PPIs) such as omeprazole indefinitely but some patients are able to taper off of them. Do note that sudden stopping of PPIs is associated with “rebound” symptoms, so this is a medication that should be tapered rather than suddenly stopped.
Again, your mother’s own doctors are the best place for you to address questions specific to her health.
OK, Thank you.
Hi,
I recently had blood tests for symptoms of thrush and frozen shoulder and rang up for the results.The receptionist told me that all was normal but my ferritin level was 10 and the doctor hadn,t reported on it yet.What does that mean.I have been told to ring back in a few days.I am a 66 year old female.
A ferritin of 10 is pretty low, and is most commonly caused by iron deficiency. As I explain in the article, if a person is diagnosed with iron deficiency, it’s important to determine whether it’s due to low iron intake (e.g. vegetarian diet) versus losing iron due to chronic blood loss.
If we check blood tests and get an unusual result that isn’t consistent with the other lab results or with a person’s symptoms, then a reasonable next step is to repeat the lab test. Good luck and I hope your doctor is able to answer your questions and pursue further evaluation as needed.
I’m a 49yo woman at 235lbs, 5’7″. Can aspirin in general, and when taken at 3,575mg daily for 2 weeks, cause anemia? Can any of the following meds (they were taken at the same time as the 2 wk aspirin regimen) cause anemia? Depakote, Lamictal, Neurontin, Prilosec, Levothyroxine, Fiorinal w/o Codeine (aspirin amt included in 3,575mg) and Excedrin (aspirin amt included in 3,575mg). Maybe the med combos can cause anemia…? Many thanks for this column and for offering interaction. It gives so many of us knowledge, empowerment and hope!
Taking that much aspirin every day sounds quite concerning to me. People can develop very serious acute aspirin toxicity by taking 10g of aspirin, so if a person were taking 3500 every day, I would be quite concerned about the possibility of chronic toxicity.
I have to urge you to contact your doctors right away to review your aspirin use. You may want to ask whether checking a blood salicylate level might be indicated.
Otherwise, aspirin can cause anemia, usually by provoking bleeding. Good luck, take care, and be sure to discuss your aspirin use with a doctor or pharmacist before continuing to take this much daily aspirin.
I would just like some insight about my father. He went to the doctor a few months ago, was diagnosed with anemia. Supplements didn’t improve the situation. So They sent him to an oncologist who didn’t seem too worried about.
Well this week he went to the doctor because he was sick (it was just a cold). They did blood work on him again. It came back that he is still anemic. They said something like there are cells that showed up that shouldn’t be there and his red blood cell count was down. They are sending him to a hematologist oncologist immediately. I do not have the numbers or any other specifics. My dad is diabetic and has been for 25 or more years.
My question is, just because they want to send him to an oncologist does that mean he might have cancer? I know a year or so ago he had a lower gi done and they put him on a watch. I know my parents haven’t been totally open with me about details (they don’t want me to worry) but I just didn’t know what extra cells meant and why they would send him to an oncologist immediately. I’m hoping you might be able to give me some insight. I appreciate your time.
Hematology is the specialty related to blood cells and oncology is the specialty related to cancers. They have a lot of overlap, and there are some cancers of blood cells, such as leukemia. Historically hematology and oncology have been combined in a joint subspecialty internal medicine fellowship, so doctors will initially receive training in both specialties and then will take both the hematology board exam and the medical oncology board exam, so that they are board-certified in both specialties. For this reason, as doctors, we often refer to “heme/onc.”
In practice, some doctors will do both hematology and oncology cases, but many end up focusing (and re-certifying their boards) in one or the other.
In terms of your father’s situation: it sounds he is anemic and perhaps his other cell counts are abnormal, or they may have done a peripheral smear and concluded that the cells look like something may be going on. So they are probably referring him to hematology, so that an expert in blood cell abnormalities can evaluate him.
I will say that sometimes such blood cell abnormalities are related to some form of blood cell cancer, but there are other reasons for the various blood cells to look unusual.
I would recommend that you and your parents try to always ask extra questions when you are told something is going on, or is abnormal. This can be hard for older adults to do, so often adult children take on this role. But of course, older parents have to agree to this, which can require several family conversations beforehand, depending on a family’s dynamics and situation.
If they don’t want to worry, you could try telling them you will worry less if they allow you to be involved and help them ask questions.
good luck!
Is hb 10.3 very low for 27 year women? I am having 10.3 hb.
It sounds low but not very low. That is assuming a woman is not pregnant. (Pregnancy causes some anemia.)
As I explain in the article, it’s important to find out if this level of anemia is new or has been present for a while, and I always recommend asking one’s doctors to explain what they think might be causing any anemia and what they plan to do next (either for further evaluation, or for treatment, or for both.) Good luck!
My mom has had smoldering myeloma for approximately 7 years now. Recently, she had a bone marrow aspiration because of a large drop in her hemoglobin, from 11.7 to 9.7. She was rechecked two weeks later and it dropped to 9.4. The bone marrow did not show evidence of Myeloma at this point. (10-15%) FISH panel was normal as was chromosome analysis. She was also tested for myodyplastic syndrome and this was negative as well. Iron levels are normal (Iron,Total 46 mcg/dL TIBC 185 mcg/dL Transferrin Sat 25 %, Ferritin 287.) Doctor is stumped at this point. She does have bad hemhorroids but hasn’t been bleeding much as of late. Any thoughts on what might have caused this sudden drop in Hemoglobin despite being in the 11+ range all along ?
I believe blood loss is the most common cause of a sudden drop in hematocrit. If a person has normally functioning bone marrow, within a few days this should cause an increase in reticulocytes (immature red blood cells), because the bone marrow will crank up red blood cell production in an attempt to compensate for the anemia.
You could try asking the doctors if they think your mother’s hemoglobin drop is more likely due to blood loss versus a production problem.
Another thing we do, when there’s a sudden drop or change in lab value, is repeat the test. Sometimes the lab got a “weird” reading, it just happens sometimes.
In her case, the recheck was in the same range (9.7 versus 9.4). If they have investigated and not found a cause, then it would be reasonable to check again in 1-2 weeks, to see if the count has stabilized or if it’s still going downward.
Good luck!
Hi Doctor,
In 2015 my hb was around 10 and I have diagnosed with ITP later in the month of April hb becomes 9 and in June July it got down into 8 and in the month of November it further reduced to 7. I have done endoscopy and colonoscopy where they have found helicobacter pylori like Bacteria. Now I have pain and cramps in stomach also I have hemorrhoids ( internal and external ) which is bleeding for last 6 years. Now I am really worried please reply me
Sorry that you are having these symptoms and low red blood cell counts, it certainly does sound worrisome.
Unfortunately, it’s not possible for me to say what might be the cause of your low hemoglobin, this is something you will need to ask your doctors. You may want to ask them what they think is the cause of your anemia, whether they think it’s related to bleeding (and if so, from where), and also what is the cause of your abdominal symptoms. Good luck!
I am 77 years I have been getting 4000 procript injection for about 2 years every month then ever other month. I went and had a knee replacement and hemogloblin went from 11.5 to 9. Then I had a blood transfusion which got it up to 10.6. Today I went a month later and it’s 10.5. My iron is good. I can not receive any more procript as insurance won.’t pay due to I went off the pattern when I got knee replacement. My kidneys are at 40 percent. He says I am good but I still am concerned. Do you have any opinion ?
Procrit is epoetin, an erythropoiesis-stimulating agent. I am not exactly sure what “kidneys at 40%” means, but it sounds like you have some chronic kidney disease (CKD) and have been treated with Procrit to treat CKD-associated anemia.
According to the UptoDate chapter “Treatment of anemia in nondialysis chronic kidney disease“, “The optimal target Hb level for CKD patients is not well defined.” The authors of the chapter say they try to maintain hemoglobin levels between 10 and 11.5 g/dL, using the lowest possible ESA dose. It seems that their target is based on their expert opinion and clinical experience, rather than on definitive randomized trials.
You should discuss your concerns with your usual healthcare providers, as they know you and will also have relevant experience managing anemia in people with CKD. If you are concerned about your hemoglobin dropping while you wait for your insurance to resume covering Procrit, I recommend letting your doctors know, and asking what would be a reasonable way to monitor for any worsening of anemia. Good luck!
My mom aged 46 is suffering from anemia (6.9)
She got mensurational cycles two times this month which caused heavy bleeding.
Dr. Has advised iron supplements but iron doesn’t suits her she gets stomach problems
What can be done? To increase blood levels
If she is anemic due to heavy bleeding, it’s important for the doctor to find ways to reduce or stop her bleeding. So I would recommend asking for more information on how they plan to do that. Usually to reduce her bleeding, they would need to first determine what is causing such heavy uterine bleeding.
Iron deficiency is very common in people who have known bleeding, but you may want to ask if they’ve confirmed that she is iron-deficient and requires supplementation.
In terms of iron supplementation, it’s true that gastrointestinal side-effects are quite common with oral iron. Be sure to let her doctors know she’s experiencing side-effects. Sometimes it’s possible to make oral iron tolerable, by changing the formulation or switching to a lower dose. For those who cannot tolerate oral iron, IV iron is sometimes required. Good luck!
Hello, and thank you for this useful information! I am a 66 year old woman and as a result of routine blood work done at my yearly physical, I found out that I have severe anemia. The original HGB level was 7.9. Shortly after this diagnosis, I went to the hospital with a bowel obstruction (my third), where I was given an infusion of iron. I am currently taking ferrex 150 and have had an EGD and colonoscopy, both of which were normal. I do not take any aspirin or other NSAIDS. My RDW is high at 21.5. My iron level is 24 with % saturation at 6. My B12 and folate are normal. Your thoughts, please. Thank you so much.
Please see this comment and the article below, regarding iron deficiency anemia when endoscopy is negative. It is not terribly rare, and you may eventually need additional evaluation.
Outcome of endoscopy-negative iron deficiency anemia in patients above 65
I would basically recommend you keep asking your doctors lots of questions as to what they think is going on, and what they plan to do next. You may also want to consider a second opinion with either a hematologist or gastroenterologist. (I don’t do second opinions on this site, I just point people towards useful information or share the basics of the medical knowledge base.) Good luck!
Hello! I’ve recently had three units blood after discovering anemia thru. Shortness breath they say probably loss blood. I check motion. To old for periods Don’t want to have test can their be an alternative such as iron. At the moment I’m fine having blood test every two weeks all ok at the moment. I reallly don’t want tohave ct doesn’t bare thinking about. Can I take alternative like iron iamgood ateating food with iron just needed some one to. Talk with as I live alone no family now yourhelp would be appreciated Ruby
Sorry to hear of your situation.
For people with blood loss, iron is mainly helpful if they appear to be low on iron levels. But it’s also very important to find out why a person is bleeding, especially if the blood loss seems to be ongoing. (But even if it wasn’t, it’s good to know why someone had bleeding, because that makes it easier to prevent for the future.)
If you are having blood tests every two weeks and your red blood cell count has remained stable, that’s certainly encouraging. I would recommend you talk more with your health providers about how likely you are to benefit from further evaluation, and/or from iron supplements. If they tell you that you might benefit, but you might also be ok continuing as you are now, then you might feel better about what you are doing. Whereas if they strongly urge you to get further evaluation, you should take that under careful consideration.
Especially if you have no family to help you think through this situation, you may want to see if you can find an online or in-person support group to help you. You can connect with others who have a similar health condition at SmartPatients.com, for instance. Or a local center for older adults might have a group in which people can discuss health concerns and support each other. Good luck!
My 92 year old father has had a decrease in hemoglobin. I have limited information. I believe his baseline is 9.6. He complained of itching and the doctor where he lives in senior living ordered blood tests. His hemoglobin came back 7.2. Apparently it was retested several days later and came back 6.2. The doctor wants to hospitalize him in order to do invasive tests to figure this out and after consulting with him and the rest of the family we have declined hospitalization. What steps can we ask the doctor to take within his current living environment to diagnose what is wrong and keep him comfortable? We are not going to put him through anything invasive. I should mention he is in palliative care currently. It’s very difficult to get good, solid, honest information as to where we stand with him and whether this is an end of life situation if untreated. Any information you could pass along would be greatly appreciated.
Sorry to hear of your father’s situation, it does sound worrisome.
It is often reasonable to decline hospitalization or try to avoid it if at all possible, for people in their 90s who live in a facility. For more on scaling back medical care at the end of life, see this article: How to Plan for Decline in Alzheimer’s Dementia: A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress. The 5th step is about scaling back medical care and can be applied to frail older adults even if they don’t have Alzheimer’s.
In terms of what can be done at his residence, it depends on whether the doctor can come see him at his facility, to ask more questions about his symptoms and to examine him. It would also be common, for someone with a dropping hemoglobin, for a clinician to check the stool for signs of microscopic blood. The easiest way to do this is with a rectal exam, but it’s also sometimes possible for someone else to put a sample of stool on a special card, which can be mailed to the lab. (For people who are in a facility, it can be tricky to get someone to do this; you would have to ask to find out what is possible, or even have a family member camp out at your father’s bedside.)
In terms of keeping your father comfortable, we are often able to buy time and help someone feel better in the short-term by transfusing them with red blood cells. This is sometimes done in an infusion center or even in an emergency room, but might be hard to arrange at the residential facility itself.
In terms of whether this is an end-of-life situation: if his hemoglobin keeps dropping, then yes, this is a life-threatening situation. If he is palliative care right now, perhaps you can find someone to help your family better understand what is going on? If he is not on hospice yet, you might want to consider it, because a good hospice team should be able to tell you what to expect, how he would be likely to die, and perhaps provide you with more support and guidance. Good luck and take care.
Hi, my dad recently was diagnosed with anemia caused by iron deficiency, He is on baby aspirin and plavix. He was alos taking Amitiza for good 10 years. For some reason his total cholesterol dropped down too. Are there any relationship between total cholesterol and iron deficiency? 6 month ago his blood test was fine he always had hemoglobin 11 or 10 or 12 but now is 9.8. Two month ago he had abdominal cat scan and it was perfectly normal. I don’t know what to think.
I’m not aware of any relationship between iron-deficiency and cholesterol levels in older men; took a quick look in the medical literature and didn’t see much of relevance.
I think rather than dig into a relationship between these two changes, it’s probably most constructive to focus on monitoring his anemia and trying to determine what caused his bleeding. Both aspirin and Plavix increase bleeding risk, and being on both at the same time — which is called “dual antiplatelet therapy” — means an even higher risk of bleeding.
It’s often reasonable to visually inspect the upper and lower gastrointestinal tract, if a person appears to be having ongoing bleeding. An abdominal CT can show some abnormalities and occasionally masses in the colon, but is not usually considered the best way to evaluate for bleeding in the intestinal tract. Especially if his hemoglobin remains low or doesn’t improve, it might make sense to ask the doctors about further evaluation for bleeding.
I would also recommend asking them to clarify why your father is on dual antiplatelet therapy and whether it’s necessary for him to continue (as opposed to stopping one agent and using either aspirin or plavix, instead of both). For instance, dual antiplatelet therapy is beneficial to people who have had recent coronary stents, but most of the benefit is during the first 6-12 months; after that the risk of bleeding may outweigh the likelihood of benefit.
Dual antiplatelet used to be commonly used after strokes, but research indicates that this increases bleeding risk without usually reducing stroke risk (compared to being on only Plavix).
So, I think you’ll probably need to help your dad ask more questions of his doctors, and then you’ll have a better sense of what to think. Good luck!
My father had hemoglobin 5.1 level 6 wks after stent while taking plavix 75mg plus xarelto 15mg medications. Iron normal, no bleeds found. Told it is likely medications causing red blood cell destruction and bone marrow suppression.
Plavix prevents blood clots and Xarelto is another type of blood thinner, so people taking both do have a risk of bleeding. It’s interesting that your father developed such significant anemia on those drugs but actually did not have a bleed.
Red cell destruction usually causes an increase in indirect bilirubin levels (can be seen on blood tests). Bone marrow suppression is often associated with a lower than expected reticulocyte count.
Hope your father has recovered from this significant anemia.
This is an excellent, clearly-worded resource on anemia in the elderly. Thank you for sharing your time and expertise.
About 2 years ago, my 80-year-old mother-in-law complained of shortness of breath, severe fatigue, and headaches, and a blood count showed her to have very low ferritin count of 5. Her doc ruled out any internal bleeding base on a negative FOBT and a chest CT, which showed that she has a large hiatal hernia but nothing else unusual. Since then, she has been taking daily iron supplements, and will continue to take them, according to her doc, “forever.” Her levels are now in a low-normal range, and she is no longer reporting symptoms of anemia.
My question: Does it make sense for the doctor to keep her on the iron supplements “forever”? Could the supplements be masking an undiagnosed GI bleed or similar problem that should be investigated further? She has never had an endoscopy.
I would say that a negative FOBT and chest CT might not be enough to rule out internal bleeding. Most experts recommend considering endoscopy, for evaluation of possible slow GI bleeding.
Of course for some frail older adults, the likely risks and burdens of endoscopy outweigh the likely benefits; her doctors should be able to help your family discuss the likely risks of endoscopy and whether it makes sense for her to undergo them.
If her endoscopy evaluation is negative, then it might be reasonable to stop the iron supplements and see if she shows signs of blood or iron loss (e.g. ferritin and other iron studies indicating worsening deficiency, or worsening of anemia).
You might find this article relevant:
Outcome of endoscopy-negative iron deficiency anemia in patients above 65
Good luck!
I had two iron infusions and my iron level only went up a tad. Doctor scheduled a 6 week follow-up. I am 74 yrs old.
Hard to know what to say. I would recommend asking your doctor the questions in the article. How bad is your anemia and how did they conclude you were iron deficient? What is the cause of your iron deficiency and what kind of evaluation for possible bleeding have you had?
You might also want to consider getting a second opinion from a specialist.
Last but not least, you can find online communities of other people with your health condition, and they might help you figure out what to ask your doctor next. Good luck!
My mother has anemia and they are getting nowhere helping her. She has to have a transfusion every 2-3 weeks. She is getting tired and has talked about giving up several times. They have done several test, with no luck finding the cause. She has had a scope done up and down 2 times each, She had a bone marrow biopsy with negative results on that one. It seems to me that her hematologist just gave up and now does nothing. What can be done about this? She is changing doctors in March but the new one is in the same office as her current one is in now. I though about taking her to another hospital, but she refuses to get the same test done over and over again. Thank you so much.
Sorry to hear of your mother’s anemia, it must be pretty difficult for her if she’s requiring transfusions every few weeks.
Even in tricky cases where the doctors aren’t sure exactly what’s going on, usually they should have a sense of whether the main problem is bleeding versus a problem with producing the red blood cells.
It’s impossible for me to be able to tell you whether the hematologist is just not communicating effectively with your family versus “giving up” inappropriately. Even if they think her anemia can’t be cured or corrected, they should be able to offer you more information and guidance.
So if that’s not happening, then yes, I would recommend trying a different doctor or clinic. If her case is challenging, it can be better to go to an academic medical center, where the doctors often have deeper expertise or are otherwise more inclined to dig into the difficult cases.
Alternatively, you could look into one of the “second opinion” services, such as BestDoctors.com or GrandRounds.com. Here’s an article describing several such services: Second Opinions Are Often Sought, But Their Value Isn’t Clear.
Good luck!
Hi Dr. Kernisan,
I have been researching my symptoms and issues for a few weeks now and came across this publication. You truly seem to care, I’m seeing that you comment back to so many people and I seem to be in a situation where, since all of my blood work came back in the “normal” range, my doctor said I just have anxiety and insomnia. I beg to differ. I have never felt this way and wanted to share a couple numbers with you to seek advice.
I am 33 years old, very active, work full time, and raise two children. About a month ago, I started getting what I call head flutters, just odd sensations that would come and go throughout the day in my head, but no pain. About a week later, I then started feeling brain fog, wasn’t focusing as much at work, just feeling off, fatigued, not sleeping, I wake up every night in the middle of the night. I then started feeling chest pressure, my chest just feels heavy.
I started looking over my results myself to see if anything showed any clues and saw a couple numbers that were borderline low normal so I wondered if maybe I could be borderline anemic? Is it okay to take an iron supplement to see if it helps? I have no energy and I was going to the gym 3 or 4 days a week and now I don’t feel like going at all (I’m 5’6″, 125 lbs). I appreciate any feedback. The last time I called my doc’s office they just told me if I feel terrible, go to the ER. Here are the numbers that leaned towards the lower area of normal:
RBC 4.28
Hemoglobin 13.5
MCHC 33.7
Alkaline Phosphate 36
Everything else was pretty much right in the middle, thyroid was definitely high normal though! They did not check my Vit D or check on the B12 or ferritin. I’m just tired of feeling like this!
Sorry that you’ve been feeling unwell. I don’t evaluate or treat people your age, but I do know it’s not uncommon for formerly healthy people to develop symptoms but be told that everything appears normal by the doctor.
It’s always important to rule out truly dangerous things first. Chest discomfort can be caused by a lot of things. It’s uncommon for active women of your age to develop heart problems but not unheard of, and heart disease is often overlooked in women. If the pain gets worse or scary, obviously you should call 911. Otherwise, you may want to ask the doctor if there is any possibility your symptoms could reflect heart problems, or some other issue affecting blood vessels (e.g. autoimmune disease).
Otherwise, there is certainly a phenomenon in which a formerly healthy person who starts to feel unwell, experiences a variety of non-specific symptoms, but the labs come back normal, and the docs conclude that it’s in their head, or it’s depression, or it’s anxiety, or it’s too much stress at work, and so forth. These have sometimes been called “functional somatic syndromes.” They are probably related to a complicated interplay between a person genetics and body, environmental factors, and lifestyle factors.
Conventionally trained doctors working in conventionally managed practices often have difficulty helping people in such situations.
There is a new-ish approach in healthcare that seems more successful in helping people who are “medical mysteries,” it’s called functional medicine. The Cleveland Clinic has some information about this approach here: https://my.clevelandclinic.org/departments/functional-medicine/about
From what you shared, seems to me very unlikely that anemia or borderline anemia would be the cause of your symptoms. Generally it’s not a good idea to take an iron supplement unless one has a proven iron-deficiency (e.g. a low ferritin level).
If your symptoms persist, you will have to keep asking for help from medical providers. If your usual provider is not helpful, you will need to look into a second opinion, or perhaps a consultation with a provider who specializes in cases similar to yours. Functional medicine may well help. Good luck!
Hello,
My father who is 57 went for an annual physical in the beginning of January. He is about 220 lbs and 5’7″. He was diagnosed with Type II Diabetes. They also did blood work which showed iron deficiency. He has been feeling more tired recently, especially when he exercises, and he has a history of blood in his stool, but he said he hasn’t had this in months. He went for a colonoscopy in his 40’s for blood in his stool and they said it was due to fissures, so he always thought maybe it was due to that.
The CBC results:
Hgb 13.2
HCT 39.2
MCH 27.0
MCHC 33.7
MCV 80.0
RDW 13.9
Iron studies results:
Ferritin 11
Iron 48
Iron saturation 11
Iron binding capacity unsaturated 387
Iron binding capacity 435
After these results, he was placed on an iron supplement.
He went for a colonoscopy which found a 2 cm benign polyp, diverticulosis, and internal hemorrhoids.
The doctor is also referring him for an upper endoscopy.
I was just wondering your thoughts on these blood results. I am a PA student and I have learned to be worried about anemia in males, because it is usually due to something more sinister.
Is it possible that the anemia can be due to benign causes? He does have a history of taking Naproxen Sodium regularly. Is it possible he can have an asymptomatic bleeding stomach ulcer?
Sorry for the novel. I just get nervous. Especially because my uncle had anemia and was ultimately diagnosed with pancreatic cancer (not related by blood to my father).
What steps do you think we should be taking? Or are we on the right path?
Thank you,
Karlee
His anemia isn’t that bad but his ferritin level and iron studies certainly seem consistent with iron deficiency. The evaluation he’s been getting sounds reasonable.
Personally I don’t consider bleeding due to chronic naproxen use “benign,” although it’s generally less worrisome than cancer. Yes, he could certainly have an ulcer or bleeding from somewhere else in his GI tract.
It is possible to have iron-deficiency anemia and also a cancer, but I think in most situations like the one you describe, it’s usually just some slow bleeding somewhere (that is not caused by cancer).
If you’re concerned about something potentially more serious, I would encourage you to bring it up with the doctor, and also keep an eye on weight and other symptoms over the next few months. Good luck!
Hello,
My dad had repeat blood work after being on the iron pill once a day for about 3 months (he took the pill with meals, which he was unaware that it is better absorbed on an empty stomach). The results were:
RBC 4.94
Hgb 13.5
Hit 40.2
MCV 81.4
RDW 14.7
Iron 57
Ferritin 8.5
All labs went up but the ferritin went down. He was also placed on an 81 mg aspirin daily at this time. He just received an upper endoscopy which showed no evidence of a bleed. They are going to do a heme occult stool test and if that is positive, they’re going to do the capsule endoscopy of the small bowel. If it is negative, they are going to continue supplementation and monitor. We are also waiting for the results of the biopsies taken from the endoscopy.
My question is if you think this is a reasonable course to go? Could the aspirin been effecting these numbers? He stopped taking naproxen so the only NSAID he’s been on is the aspirin.
Is there anything else we should test? So confused as to why he is iron deficient and so nervous that we may be missing something.
I really can’t say whether they might be missing something. (It’s always a possibility.) His blood count overall is not that low, but his ferritin does seem quite low.
You may want to ask them to discuss with you the likely benefits and risks of taking the aspirin at this time. It is a risk for new or continued bleeding, so it might help for the doctors to clarify how important it is for him to take it at this time.
Great site! You can explain so well.!
I am interested in mild anemia and came across your site. I am 45 Male and I noticed lower HGB 13.1 and RBC 4.36 and HCT 40.0 in a report in nov 2017. I had been having symptoms of a headache after exercise or exertion. However, a blood retest in Jan2018 revealed levels are back to normal but in the starting range, 4.5 13.7, 41.2 The iron was perfect so no iron deficiency. The doctors say that anemia is not there. But I still have symptoms, tension headaches on exertion, an irregular heartbeat at times. Does these reading sound like mild anemia?
i lost weight from 2012-2016 now at 50kg underweight at 170cm. Noticed that blood pressure has lowered from 140/80 to 116/ 70 and lower resting pulse at 50 from 60. So not sure if these are symptoms of underweight or something else. I also noticed blood in stools for the past 2 years. But cannot be sure if it was blood. the fecal occult was negative.
I have anxiety and the doctors are not able to isolate the issue. I am concerned about any advice from you would help.
I think it’s unlikely that your symptoms are due to anemia. If they are persisting, then you should definitely keep working with your doctors to figure out what is causing your symptoms. If you have noticed an irregular heartbeat at times, you should be sure to mention this to your doctors. There are usually ways to monitor the heart for several days (via a wearable patch or other special device); something like this could help determine what is going on with your heart when you experience symptoms. Good luck.
Thanks for the advice. I Have been seeing different specialty doctors but they have not been able to pont the finger to any one cause for the headaches . I have done done holter and all other heart related tests. They are fine. Only minor jha plaque in artery.
I was more concerned if there is any Undetected cancer (colon) that is had caused the weight loss . And is beginning to show some symtomps .
Is there anything that I need to look i need to look Out for ?
If you are concerned about undetected cancer, then I would recommend bringing that up with your usual doctors. They would be best positioned to advise you on how to address this concern, and what might be signs of cancer given your situation.
Unintended weight loss certainly is a concerning symptom, however, if your weight has stabilized since 2016, that sounds somewhat reassuring. Of course, if you are experiencing worrisome symptoms, then you need to keep asking your health providers for help, or consider seeing a different type of doctor. There are a certain number of people who have symptoms for years and are “medical mysteries,” but some doctors are particularly good at working through those cases. In the US, some clinicians in functional medicine have had good success in evaluating these cases, because they have a more careful and thorough approach than conventional doctors do. Good luck!
Thanks for your input Dr. Leslie. Do you know of any good functional medicine doctors in the US that i can reach out to that can help.
I would recommend searching on google and asking around in your local area.
Im 65 and diabetic (A1c around 6.1-6.6) – in May 2017 A1c at 7.4 – went on low/no carb diet and gym routine – nxt A1c on August 2017 at 5,9 – fantastic but HGb and HCt dropped from a constant 14.4 and 42/44 range (since 2005) to 12.8-13.1 and 38 to 40 range – has been this way to date – all other CBC tests spot on – Dr. not that concerned but sent me for Colonoscopy which was perfect. So my question is
1. Something changed after weight loss – and no matter what I eat im at a solid 150lbs (was at 163) any clue
2, Shoulder replacement required – started advil around may timefram – could that be a problem
3. How far can they take this testing – sounds like an endless process
4. Would all my other CBC results be normal if there was an issue?
Thank you
Advil does cause some microscopic bleeding in some people, so it’s plausible that this might contribute to a lower red blood cell count. A colonoscopy inspects the colon but not the small bowel or stomach, both of which can be sources of bleeding. If there is a slow chronic bleed, often other tests related to iron-deficiency anemia (e.g. ferritin) are abnormal, but the white blood cell count and platelet count can still be normal.
The testing can indeed go on for a long time…which is why sometimes it’s reasonable to give the situation time and monitor for a bit.
Be sure to keep asking your doctors lots of questions, they are best positioned to help you figure this out.
Good luck!
Will read more of this excellent site before asking about possible reasons for low haemoglobin. Then will go back to my ( new) GP and possibly ask questions of my gastroenterologist who wants me to have a colonoscopy. My age 84 and live entirely alone. Thanks, Judy.
I’m so glad to know you’ve found this article helpful, in learning about what questions you might ask.
Generally, when considering a colonoscopy or other procedure, it’s a good idea to ask the doctors to specify how they think it’s likely to help, and what the risks are.
I would also recommend going to your medical appointments with a family member or trusted friend. No matter what age one is, it’s a good idea to have someone else there to take notes and help you keep track of what the health providers say. Also good to start “grooming” someone to be a back up who can assist with your health, as many older people will eventually need this type of help (and it’s hard to predict just when the need will arise).
Good luck and take care!
Hi. 95 year old mother, currently in a nursing home. Eats very little, aenimic,angina problems. Haemoglobin drops every few months. She gets blood transfusion. Question. Why would they let it drop to 6, before deciding she needs a transfusion. Ie, if it’s at 7, they won.t do a transfusion.
Hm, well I would recommend you ask the involved providers to explain their reasoning for why they wait until a hemoglobin of 6 rather than 7. Some research (generally done in hospitalized patients, not nursing home patients) suggests a transfusion threshold of 7 is acceptable, so perhaps they are waiting for her to drop just below 7 (e.g. 6.8)?
I hope they have explained to you why she has these persisting drops in hemoglobin. If not, I would recommend asking questions as this sounds like an important issue to address. Good luck!
This has been the most helpful article I have come across in my search for answers to my anaemia! I have been suffering for at least five years and unable to get my levels up. Living in Greece is not easy and much research is done on our part.
My latest readings are haematocrit 33,1, RCC 3700000, haemoglobin 10,5, serum iron 61 and ferritin 14,5. The doctor has prescribed ferrous glutonate but should I be pushing for a colonoscopy and endoscopy? Any advice would be greatly appreciated
Glad you found the article helpful.
Well, the main thing I recommend pushing for is an explanation. If your doctor thinks you are low on iron, ask him/her to explain what is the likely cause, and does it seem to be ongoing?
The other thing to consider would be whether you are due/eligible for colon cancer screening for other reasons. Good luck!
Ihave my homglobiean 10,6 is this bad sm woman 38 year
A hemoglobin of 10.6 is generally considered low for a woman, and would be consistent with anemia. As I explain in the article, it’s important to consider whether it’s a chronic problem or new issue, and how quickly the hemoglobin level seems to be changing. Your health providers should be able to help you with an evaluation and an explanation.
I’m deeply concerned about my partner, she’s 33 years old, mother to my three children. She’s had a consistently low white and red cell count for nearly three years (Since our youngest was born), initially the doctors were not concerned, they’d say it was probably related to a virus, send her away for a month and repeat bloods, this went on for 18 months or so before they finally agreed to send all the results to Haematology. They said a three month course of iron tablets for Normocytic anaemia should sort her out, and it did, bloods back to within normal range and all she felt better in herself, less lethargic, picking up less colds etc.
After the course of iron tablets they gradually returned to her abnormal ‘normal count’, around 3.4 for WBC and yet again they send her away and repeat bloods in a month, ad infinitum.
At what point do we push this? Or push in the extreme, i’ve tried everything I can to push our GP to look into it further or just give us an answer as to what she think the underlying cause is and why she doesn;t seemed concerned in the slightest! It can’t be normal and i’m deeply concerned there is something sinister going on.
Kind regards.
Well, I can’t really say at what point you should push or anything like that. Her WBC count is borderline low, so it may or may not be of significance.
What is more interesting to me is that you say her blood count got better with iron supplements. So, you may want to ask them if she had signs of iron deficiency (e.g. was a ferritin checked) when they decided to prescribe iron, and have any of those signs come back? If she is iron-deficient now, the question would be why.
Otherwise, it’s certainly too bad that the GP seems unable or unwilling to tell you what she thinks is going on. If you are concerned and the GP doesn’t seem to be helpful, then you may want to consider a second opinion with a hematologist. Good luck!
Dear Leslie Kernisan
Need your good advice urgently.
My mom is 88 years old, she has been diagnosed with low blood count, about 8 points and also irregular heart beat. Few days ago she had a mild heart attack.
Heart doctor wanting to give blood thinner to her but worry she might have internal bleeding that causes her anemia. We are reluctant to do colonoscopy given her age.
To us, currently she looks pretty fine except a bit weak. She can sleep and eat and doesn’t look like there is any internal bleeding.
What’s your take on this?
Thanks in advance.
Taking a blood thinner does increase the risk of internal bleeding, or can worsen an existing small bleed. Is there a very big and important benefit in taking the blood thinner right away? (This is the kind of question you need to ask her doctors; I cannot answer it because it depends on her particular health circumstances.)
If not, then it may make sense to wait a bit and try to find out why she became so anemic. Your doctors should be able to tell you whether a colonoscopy is likely to be very risky given her age and condition. There are also other ways to check for internal bleeding. Last but not least, waiting for a period of time and seeing if the blood count stabilizes is another potential approach that can be used. good luck!
Thanks for your advice. Pls let me know what other ways to check for internal bleeding? The doctor’s said that’s the only way and every operations carry certain risk.
The blood thinner is to prevent her from having heart attack or stroke which according to the doctor, is about 15 to 20% yearly.
They should be able to test her stool to see if there are signs of microscopic blood. Also, you can ask whether her ferritin was low, or did she have other signs of iron loss.
Re the blood thinner, atrial fibrillation in of itself increases stroke risk, there are calculators available online, a commonly used scoring system is called “CHA₂DS₂-VASc.” Usually in people your mother’s age, their stroke risk is 5-12%/year. She will also be at risk for a heart attack but that is fairly high in everyone her age, especially if they’ve previously had one related to a coronary artery getting blocked.
It often does make sense for older adults with afib to take blood thinners; whether the likely benefits of her starting one right away outweigh the risks , compared to perhaps waiting a few weeks; this is one thing you might discuss with her doctors.
I have been told I have anemia blood count 10.00 I am 71, I have had a sigmoidoscopy, a virtual colonoscopy I am due to have a gastrostomy next week, the sigmoidoscopy was OK, have had the results of the scan yet, I also have bad nights sweats could you give me any advice
I don’t have any advice beyond what I have written in the article and other comments. Ask your doctors to explain what they think is the cause of your anemia and you may want to ask if you show signs specifically of iron deficiency. There are many potential causes for night sweats, you should discuss with your doctor and you can ask if your doctor thinks it’s likely to be related.
Hi there (and thank you for the informative article and responses).
I am a 65 year old female and in great health (I thought). Out of curiosity I started taking my blood tests and have become concerned about anemia. I am quite active and not tired at all but my Hb ranges from 8.1 to 14 and my HCT ranges from 26% to 38%. This seems quite low, but with no obvious symptoms or fatigue or weakness I wonder if I need to explore it further? I have always had fairly low blood pressure.
I climb mountains, work on a farm, exercise regularly and am fairly lean. I do practice a low carb diet. I am confused about my feeling of good health and yet the low blood markers. Can you help me understand?
Hm. It is normal for everyone’s blood counts to fluctuate a bit, but what you describe is a really big range. (You don’t say over how much time these results have been gathered.)
A hemoglobin of 14 is normal but a hemoglobin of 8 would be considered pretty substantial anemia. (It would also often cause symptoms, like fatigue on exertion.) If someone usually has normal numbers but has a single low value, we often attribute it to lab error, and in fact, for any abnormal result of concern, a common next step is to repeat it to make sure it is “real.”
Especially if your recent results have been abnormal, I would encourage you to discuss it further with your usual health provider, even if you are feeling well. They will probably want to consider what the trend has been with your results and how fast it has been changing. They can then advise you as to what the next steps should be. Good luck!
Hello,
My dad is 84 years old of Indian origin. He is hypertensive and also has angina. A few weeks back he had diarrhoea which led to dehydration and was thus hospitalised. The stool test confirmed salmonella and following antibiotic treatment he recovered. However follows this episode he had atrial fibrillation with heart rate reaching 150 at times. The doctor started him on digoxin and eliquis for blood thinning. His appetite was affected and he lost almost 5 kg due to this illness. His last blood report showed haemoglobin 119 where normal was 138 and above, his iron was 10.3 whereas normal is between 10.4-28. Now the thing is he’s always been slightly anaemic when he was in India the doctors in England have referred him to a colorectal specialist for investigation. I understand this is protocol but his reports of last two years show the same haemoglobin level and there hasn’t been any change. So my question is does he need to see a specialist for investigation or since he’s been through the salmonella infection this iron level is expected. Thanks
Hm, a hemoglobin of 119 doesn’t really make sense but perhaps you mean 11.9. That is a little low for a man and could be consistent with his history of “always been slightly anemic.” His iron level is quite close to the normal range as well.
I don’t know if the salmonella infection would be expected to affect his iron levels. I would recommend asking his doctors this question, and also asking them to explain in more detail why they think further evaluation is likely to benefit him. You may also want to ask if they are concerned that he might bleed due to his new blood thinner.
For the most part, if you are hesitating about pursuing additional evaluations recommended by health providers, the thing to do is ask “what is the downside of not doing this, or not doing this now? Is there another way to monitor things for now?”
Good luck!
Hi,
I am a 41 year old female recently diagnosed with iron deficiency anemia. I was very fatigued, had horrible sensations in my head, dizziness, insomnia, heart palpitations, and my legs hurt really bad. I had two iron infusions and my levels returned to normal. I am no longer fatigued, I have no more palpitations and my legs don’t hurt anymore, however, I am still having those sensations in my head accompanied by some dizziness. How long should this last? How long does it take after your blood returns to normal for all symptoms to subside?
Sorry to hear of your recent anemia. I’m not a hematologist and I’m not very familiar with the type of head symptoms you are describing. For more typical anemia symptoms (fatigue, shortness of breath, high heart rate), these improve quite quickly once the red blood cell count is brought back up.
I would recommend asking your doctors about your persisting dizziness and head sensations. You may also want to talk to them about why you became iron-deficient in the first place. If your doctors aren’t sure, you may want to consult with a hematologist. Good luck!
Hello
In late October 2017 I was diagnosed with Anaplasmosis. I spent 4 nights in the hospital-the first 4 of my now 69 years. My CBCs revealed very low numbers for red cell, hemoglobin, iron etc along with near critical white cell and platelet counts. With antibiotics things got turned around. They said that the stamina related #s (anything related to red cells) would be slower to come back than the others. They continued to do CBCs until mid December. Things moved in the right direction but were still low. I was changing primary care doctors at this time due to a retirement. I had a physical scheduled with him in early March. They took blood at that time but did not do a CBC! I was told that since I was moving in the right direction in December, they didn’t see a need. I am well known for my stamina among my friends and peers. For example, in October 2016 I did a Rim-to-Rim hike in the Grand Canyon without ever sitting down. I can do stuff like that, normally. I m very active and know my body, and I know it isn’t right. I finally requested a CBC in April. Most of the numbers were lower than in December. The doctor immediately prescribed iron. (I had been taking a vitamin with iron since October). I started that but then I looked closer at the test results and noted that my iron is no longer low, it is toward the high end of normal (160). The hemoglobin is 12.1. My transferrin saturation is 53% with was indicated as high. A quick internet search says that high transferrin saturation is a sign of iron overload. So I am wondering whether I should be taking iron? Is the slow recovery of red cell related numbers to be expected with Anaplasmosis? I know my body is not right. Thank you if you are able to help.
Anaplasmosis is an uncommon disease caused by a bacteria carried by ticks. I don’t have any experience with it, so not able to say what is usual during recovery. You may need to contact an expert in this disease to get your questions answered.
I do agree that the iron test results you share aren’t consistent with iron deficiency. I would recommend discussing this with your doctor and asking them whether you still should take iron. Good luck!
Thank you very much for your reply. It seems that you have a lot of company regarding experience with Anaplasmosis. It has been a real challenge to find any definitive information. You mentioned that I may want to consult an expert on this disease. Do you have any suggestions as to where I might find one?
You could try calling the hematology and also infectious disease departments of your local academic medical center, to see if any of the clinicians specialize in this condition. You can also search Pubmed to see which doctors are publishing research on anaplasmosis. good luck!
I was diagnosed with anemia after my hemoglobin reached a red flag level. On looking at my history my hemoglobin had actually been dropping slowly over a period of years. I suffered from exhaustion and sob with minor exertion. Last year I also had severe GERD esophagitis with probable bleeding. It was treated and after total scopes, there was no bleeding found.
I am now taking iron, folic acid and B12 as of a few weeks ago. I still have the sob but am not as tired. My doc says it took some time to get to the present stage and that it may take some time before my system returns to normal.
Does that sound reasonable and I should give it time? My heart and lungs have both been checked out and are normal.
Thank you for all the wonderful information you provide for us ol’ folks!!
Yes, shortness of breath (SOB) can be caused by anemia, but it can also be caused by any number of heart or lung conditions, so it’s good you had those evaluated.
You don’t say whether your hemoglobin has returned to a normal level or not. If your red cell count is normal, then I’m not sure you should assume that any fatigue or shortness of breath with exertion is due to your past anemia, because as far as I know, those symptoms resolve fairly quickly once the blood count is normal.
There are, of course, many other reasons to feel fatigue. And some people feel short of breath with exertion because they are out of shape. In fact, if you were slowly getting more anemic over years, you may have been restricting your activity and so even if your heart and lungs are “normal,” it would be possible to have low cardiovascular fitness.
I would recommend discussing your current symptoms with your doctor. Good luck!
My hemoglobin has returned to the bottom edge of the normal range but I still suspect that since it had been dropping for years that my iron was so low that it has not nearly returned to normal.
My doc suggested that I try some walking – just a short time and try to add time. I know that have not been physically active for some time so even if anemia was the base cause, I know that I am now deconditioned also.
Thank you for all the time you give to helping us deal with the perils of aging. Bless you!!!
Hi,
I am 60 years old, and have anemia. Numbers have been in steady decline for a year or more. I started low calorie dieting Sept 28 of last year. I tracked cals, carbs, fat, fiber, & protein, and kept all in balance, albeit low. I switched from loss mode to maintenance mode in March of this year. I dropped from 265 to 160. During that time my hct went from 43.4 to 37.8, hgb 14.9 to 12.8,rbc from 4.74 to 3.87 mcv from 91.5 to 97.6. My stool cards last month were normal. I take a multi vit daily, as well as a b complex, osteo biflex, calcium magnesium & zinc, & vit C, twice a day fish oil & vit E. I also take a low dose aspirin, 100mg diclofenic, amlodipine 5mg, hydrochlorothiazide 25mg, rosuvostatin 5mg, & omeprazole 40mg, once daily. Iron is at 55, no previous to compare, B-12 is at 477, Folic acid is above 20, actual number not given, feritin at 247. Latest bloodwork was done this week. Docs office called me last night, wants me to get fully scoped, both ends, ASAP, said the surgeons office would call me today to schedule. The girl that called me got very very insistent when said I might be hard to reach today, due to work.
Bottom line, now I’m scared. What am I likely facing?
Well, it’s impossible for me to say what you are likely facing. I can certainly see why it’s alarming to have the medical office being so insistent in this way, hopefully they will explain themselves soon. Losing 100 pounds in 9 months is a lot of weight loss, I wonder if that is part of their concern.
I would recommend you ask them to explain what is their current thought regarding the cause of your anemia. You can also ask if they are concerned that your weight loss might be due to something other than your dieting, and you can ask them to clarify what is the purpose of the scoping they are proposing. Good luck!
Thanks 🙂
Testing is the 29th, guess I’ll find out then. I’ve come to terms with it, it will be what it will be & I’ll dael with whatever it ends up being, jus had me rattled for a bit, I’m ok now, thanks again.
My 90 year old mother has fallen twice within the last 6 weeks. Her most recent fall needed a trip to ER (CT scans and exams were performed). She was sent home with tx of ice packs for swelling on her cheekbone. 4 days ago, after her re-check w/her internist, she was sent to ER ASAP due to the 6.2 g/dl hemoglobin result (CBC drawn that morning). Two pints blood transfusion given. She is an Alzheimer’s pt. with hx of TIA, hypertension and adult onset diabetes. Among other meds, she is on Plavix and aspirin. My father, mother and I are seeing her MD in 6 days and I am hoping you can advise me of some pertinent questions to ask him.
Thank you in advance for any guidance you can offer us and for your website.
Well, a hemoglobin of 6.2 certainly is quite low. Since she had been evaluated at the ER four days prior, I would guess they’d checked her CBC then as well, and so her blood count dropped after that first ER visit? Some questions you could ask:
– What do they think is the cause of her drop in hemoglobin? Has this resolved? What is the plan for following this?
– Blood-thinners such as Plavix and to a lesser extent aspirin are risky for older adults who fall, because they increase the risk of bleeding after a fall. How important is it for your mother to continue these medications? Why is she on them? What would be the risks to her health if she were to stop taking those medications? Has your mother perhaps reached a stage in her life and health in which the risks of these medications (which tend to go up as people get older) may be outweighing the likely benefits (which tend to get smaller as people get older and frailer)?
– What do they think is causing or contributing to your mother’s falls? Has she been evaluated for causes that could perhaps be corrected or addressed, such as medication side-effects or low leg strength?
We have more articles on evaluating and preventing falls: Preventing Falls in Aging Adults
You don’t say how far along your mother’s Alzheimer’s is. I do have an article on anticipating future decline, it may give you ideas on what to discuss with her doctors: How to Plan for Decline in Alzheimer’s Dementia:A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress.
Good luck, I hope these ideas help!
Perhaps I should have finished info on my recent iron panel: Iron level 151mcg/dL
Iron Binding Capacity 231/ mcg/dL; Iron level 151 mcg/dL; Ferritin 79; Transferrin 165.
Thanks, john
Hm, this is the only comment I see from you. Not sure what your question is, but in general your iron level and ferritin appear to be in normal range, so if you’re concerned about anemia, iron-deficiency would seem less likely as a cause. I would recommend discussing your questions with your usual health providers.
This is my third attempt to re-post the preamble of the above:
I am 63 year old Hemochromatosis pt. Routine phlebotomies over the past three years resulted in a drop in ferritin from 1300 to below 50. However, I have not been able to continue my treatment in the past year due to low HCT (38.6%) and HGB (13.2). My ferritin is up to 79 with Iron Binding Capacity 231/ mcg/dL; Iron level 151 mcg/dL; Transferrin 165. I had recent neg. occult blood test. My blood pressure fluctuates between low and high. Recently it has mostly been low 110/62. But in the past month it has gone as high as 160/99. (all resting readings). I feel mildly anemic or maybe just old. I have otherwise maintained athletic physical condition (normal BMI). I push myself. Should I be concerned? I have taken B-12 for past year. I have also maintained a ketogenic diet for past three years. Recently I would call it low carb/high fat diet. That is, I don’t worry about staying in Ketosis anymore.
I hope this post finally shows up. I am eager to hear another opinion.
I am also wondering if I would be considered “Iron Avid” at this point. My physiology works at storing rather than using iron. Possible?
Sorry if you’ve had difficulty posting to the site; we are planning to eventually change the commenting system but it’s not something that can be changed easily.
Unfortunately, I don’t know much about hemochromatosis. I would recommend that you consult with a hematologist or other expert with training in the management of this condition. In general, if your blood count is trending downward, that does sound like an issue that merits further investigation. Keep asking your doctors lots of questions and good luck!
I m 19 yrs… And my haemoglobin had fallen to 6.5 suddenly… What can be the reason for this
Sorry to hear of your hemoglobin drop. I have listed the main reasons in the article. The more common causes are a little different in people your age than in older adults. I would recommend you ask your doctor to explain what might have caused your anemia. good luck!
I just found out two weeks ago that my hemoglobin level is 7.0. I have blood work regularly as I am a diabetic and four months ago all was normal. Just had a colonoscopy and endoscopy and nothing found. Doc said all other counts are normal. I am being referred to a hematologist and have started iron supplements. I’m 65.
Should I be asking my doctor or the specialist about the ferratin level? I feel I want answers quickly but not really getting them. Should I ask for a cat scan orsone other cancer test? I’m a bit concerned as this has really slowed me down. I’m a software developer and getting so fatiuged is concerning.
By the way, I found the article and your responses very informative!
Glad you found the article helpful.
Hm, a hemoglobin of 7 is not trivially low. I would encourage you to ask your doctor more questions about what kinds of tests they have done to determine the underlying cause. I do think it would be reasonable to ask if they checked the ferritin, and why they are having you try iron.
The hematologist may be able to advise as to whether you’re likely to benefit from CAT scans. Good luck!
My 92-year-old mother is in a facility for rehab and possibly will go into skilled nursing. For almost two weeks they have been doing blood draws that show her Hematocrit at 21 and 22 and her Hemoglobin at 7.2-7.4. I’m not sure why a plan of action has not been formulated to correct this. Is it normal to wait that long? In the past she has had blood transfusions, larger doses of iron and B-12 shots for low Hemoglobin. I’ve spoken to the nurse who just says the doctor has not ordered any changes yet. Any advice?
It’s hard for me to say whether what they are doing is “normal” or not. You say she’s had transfusions and iron therapy in the past, so it sounds like she has a prior history of anemia. Her recent hematocrit of 21 may or may not be due to the same cause.
I would mainly recommend you ask the doctors a lot of questions, so that you can better understand what is going on. First of all, I would recommend asking them to clarify what was the cause of her prior anemia, and then I would recommend asking whether her more recent anemia seems to be due to the same cause or not. If they aren’t sure what is the cause, ask what they plan to do to figure this out. And then of course, ask them what their plan is for monitoring and correcting her current anemia.
You may also want to discuss the goals of her medical care with them. At age 92, some older adults — or their families — have opted for less intensive medical treatment. How aggressively they monitor and manage her anemia may depend on what they think are her priorities and goals, when it comes to her medical care. Good luck!
I am 87 years old and my hemoglobin has been steadily declining. It recently fell from10.2 to 9.8 and my hematologist has put me on weekly injections of Procrit. The result has been an almost constant state of exhaustion. My iron and B-12 levels are normal. Do you have any suggestions? Thanks.
A hemoglobin change from 10.2 to 9.8 is pretty small, both are close to 10. Now, 10 is not considered normal, that is what we’d usually consider moderate anemia, and of course must be considered in light of what your hemoglobin has been in the past and the rest of your medical history.
I can’t make any suggestions re treatment. I would recommend that you ask more questions in order to better understand what your doctor thinks is causing your anemia, and what their plans are for further evaluation. You may want to ask what other tests they’ve done so far. If Procrit doesn’t help you feel better and doesn’t improve your blood count, then you may want to ask them whether they think you should continue and if so, why.
Good luck!
Dr. Kernisan,
In the last year my Hb has dropped from around 13-14 to the 9-10 range. I am a 69 yr. old male and feel fine not noticing any of the side effects of being anemic. I exercise around four hours per week along with working outside in the yard without any excess fatigue.
About a month ago I mentioned to my regular doctor during a six month check up that the last few times I attempted to give blood I was turned away because of low Hb levels down to 11 two months ago.
My doctor’s routine fasting lab test prior to the visit did not include Hb thus a second lab test was run to determine my Hb level. Then a follow up stool test was positive.
He thus ordered colonoscopy and upper endoscopy. Before those tests occurred, he arranged an appointment with an oncologist which I saw today. The oncologist cancelled both the mentioned tests and arranged a bone marrow aspiration and biopsy.
I noticed above you suggested a peripheral smear was typically done prior to the bone marrow test. Is there a down side to not doing the smear test first and skipping the scope tests?
Thank you very much.
A peripheral smear is often done before a bone marrow biopsy because a peripheral smear is fairly easy on the patient; the blood is collected via an ordinary draw. Whereas a bone marrow biopsy is more of an undertaking. If a peripheral smear shows cells that are abnormally shaped, or otherwise suggest a problem with the bone marrow, then there is more of a justification for putting a person through a bone marrow biopsy. (Getting a sample of bone marrow takes more work than getting a sample of blood.)
It’s impossible to say whether there is a downside to skipping a certain type of test. Whether a test is likely to help depends on what else is already known about the patient, and what the clinicians are now trying to figure out. Perhaps your ferritin was normal and you had no signs of iron-deficiency, despite developing anemia.
I would recommend you ask your health providers to explain why they think it’s best to cancel your endoscopy (which is also not a trivial procedure) and instead proceed to bone marrow biopsy. Good luck!
Thank you for the information. I guess the upside of the bone marrow test is that likely more information will be gleaned than with a peripheral smear. Will the bone marrow test determine if the blood cells that are abnormally shaped?
I will certainly followup on cancelling the endoscopy since the stool test is positive. The oncologist simply said that since my last endoscopy was only two years ago there was no point in doing one this soon. Does that logic make any sense?
Thanks again.
The shape of cells in your blood can be seen on a peripheral smear. A bone marrow biopsy allows them to see the shape of the precursor cells that are in the bone marrow, and also will allow them to see if there’s anything else unusual in the marrow itself, such as surprisingly large (or small) numbers of certain types of cells, etc.
Endoscopy is actually often reasonable after a positive stool test, because the endoscopy helps clinicians figuring out just where in the bowel the bleeding is coming from, and what is causing it (e.g. an ulcer? a polyp? an inflammatory condition of the bowel lining?). Generally the type of colonic polyps that can bleed or become cancerous take more than 2 years to emerge, so that may be why the oncologist feels this test is unlikely to be useful. However, if there’s a possibility that you have an ulcer or something that’s not a polyp, and if it seems like you are still bleeding from inside your GI tract, then endoscopy might make more sense.
In short, whether it makes sense to proceed with a test — or cancel it — depends on a lot of things. The most important thing for you to do is ask a lot of questions of your doctors, to understand why they are proceeding in a certain matter. Good luck!
Hi, I have been feeling bad lately, low energy no get up & go, blood tests have been ok but still have energy problems. I am 75 year old female. I do take 500mg b12 & 100mg b6 once daily. along with b complex. could I be low on iron, would that show up on blood test, or should I increase my b12. I’m use to being very active, but don’t have much energy lately. By the way, I took a prolia shot 6 months ago for osteoporosis & have been feeling bad ever since. I’m due another one in a week but don’t think I’ll take it. I mentioned this to my Dr. she said it wasn’t the prolia. what do you think. Thanks so much.
Sorry to hear about your low energy. Yes, anemia is a possibility, and it could be due to low iron or due to any number of other causes.
But there are also plenty of non-anemia medical reasons for a person your age to feel low on energy.
Really what you need to do is see a health provider and ask to be evaluated for your low energy. Normally they will ask questions to see if you have any other particular symptoms that might point to the cause of your low energy, they’ll do a physical exam, and then in most cases they will order a blood count but also a metabolic panel and possibly other blood tests. I cover commonly ordered blood tests here: Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
In terms of whether it might be the Prolia: that’s a much newer medication for osteoporosis, I don’t have much personal experience with it and generally the difficulty with newer medications is that side-effects aren’t well known. That particular medication is not recommended as first-line treatment in Uptodate because of this, and also because the bones start weakening again fairly quickly if one doesn’t continue it (whereas this is not really an issue with bisphosphonates, which are usually first-line treatment). In short, there are more downsides with you deciding to not take your next Prolia dose than there would be with stopping many other types of medication.
I would recommend talking to your doctor about your fatigue, and also about the pros/cons of continuing Prolia. You could also consider asking her if it’s possible to postpone the Prolia for at least a few weeks while you get evaluated for fatigue. Good luck!
Hello Dr. Kernisan,
I’ve suffered from heavy menses since I was 10 years old and would have to change pads every hour, but every month on time and lasting exactly 7 days. When I reached 40 I started wearing depends because of the heavy flow. I am now 45 yrs, but the last year my cycle has been unpredictable; one month not coming at all, the next month lasting weeks, the next month very light. At 39 I had a blood transfusion which required 5 bags of blood because I was told the heavy flow was due to me having fibroids and needed to have an operation to get them removed. Does that mean I had fibroids at 10 years old too when my cycle began and my flow was just as heavy? I decided not to have the surgery. However, I have had many blood transfusions since then because I am told my heavy menses causes me to have severe anemia with blood counts as low as 4.9 (December 2017) but never higher than 8. The transfusions make me feel better but I just bleed it out in 1-3 months. I’ve opted to stop getting the transfusions (my blood count now is 6.5, August 2018) due to the risks of transfused blood. Since 2014 I’ve had many seizures and faintings And I was diagnosed with epilepsy. As time goes on, I can’t remember most things, I don’t want to do anything other than be by myself, I’m cranky and irritated most of the time, I’m sore and out of breath, I have anxiety, the list goes on. I’ve been told to eat healthier but I’m wondering is this because of me getting older? Please advise and thanks for your advice…your website is very helpful and informative!!! 🙂
Sorry to hear of all these health concerns you’ve had to deal with. You are 45 and it sounds like your anemia is very much related to these gynecological issues. I can’t answer your questions, I would recommend you find a good gynecologist, perhaps one who specializes in treating patients with unusually heavy menses and/or fibroids. Good luck!
Hi Doctor.
54 y.o. man here. Generally healthy in every other aspects. Non smoker for 2 years now, drink 2-3 glasses of wine a day, excercise regularly. That said I’ve consistently had low red blood cell counts for the last few years but seems stable (4.5 ish), Hematocrit at 0.40 and Hemo at 135.
As mentionned, it appears to be stable for the last couple of years (since I started taking regular tests). Otherwise, I do feel a little less vitalized than I used to but always thought it was just aging.
Should this be of any concern? Is a lower-than-average type of condition sometimes ”just ther way I am made”?
I don’t think I’d describe the numbers you share for hematocrit and hemoglobin as low, they are on the lower side of what’s often described as the normal range but that’s usually ok. Also reassuring that your counts have been stable. This could indeed be “the way you are made” but of course it’s impossible for me to rule out some other cause or factor that is making your count a little lower than it otherwise would be.
As to your feeling less energetic than before: hard to say whether this is “just aging” or not. There are actually many different things that can cause a person to feel less energetic at your age.
I doubt it’s your low-normal blood count but there are many other possibilities that are fairly common in your age group. I would recommend talking with your usual health provider. They should ask more questions to see what other symptoms or problems you are having, they should do a physical exam, and they might order additional bloodwork or studies, depending on what you’ve been checked for in the past and your personal medical history. good luck!
Hi, I appreciate your posted info on low hemoglobin. I have been battling with very low hemoglobin for the past 5 years now. I was just hospitalized for 15 days from it. My doctors can’t seem to find the answer to my problem. I have had many tests such as CT Scans, MRI, Bloodwork, lower Gi and upper Gi where they used a scope to see inside my large intestine and lungs, I have been hospitalized many times to only find nothing wrong. I crave ice, my arms and legs feel very heavy, my heart races when I do things, when especially climbing stairs. I have really bad headaches with no energy. My b12 is good and I am taking liquid iron that’s all natural and it doesn’t make me sick. I’m tired of having outpatient IV’s to get iron or blood transfusions. I really need to find out the cause so that my problems can hopefully be corrected if possible. Right now my quality of life is far from where it should be. Any advice?
Sorry to hear of your persisting anemia. Craving ice or other non-food items is called pica. This symptom has a known association with iron deficiency, although it may also be associated with other micronutrient deficiencies, such as zinc deficiency:
A meta-analysis of pica and micronutrient status
Hard to say why your doctors haven’t yet found a cause. Presumably, they have done an adequate first pass evaluation and are not overlooking anything obvious. So it might be something more unusual that is causing your anemia. You could try getting a second opinion, if you haven’t already done so. You may want to consider contacting a specialty academic center, as they are sometimes better able to figure out “medical mysteries” that have stumped other clinicians. You could either look for someone specializing in refractory iron-deficiency anemia, or try the “Second Opinion” services available at some of the top level academic medical centers, such as this service at UCSF: UCSF Health Second Opinion.
You could also try using a service such as PatientsLikeMe or SmartPatients to find other people with a similar “hard to explain” anemia. Sorry I don’t have an easier answer for you, unfortunately the answer is usually to ask more questions or find someone else to ask. Good luck!
Dear doctor, I am so happy to find your site. My father is 81, almost 82. Always had back pain, lower blood count and weak kidney function since 20 years ago. He had severe reaction to pneumonia vaccine over 15 years ago, and had bad allergies during allergy season. Beginning of this year back pain has gotten really bad eventually lead to loss appetite, mild fever, jaundice. Urgent care doc just did dipstick and sent us home with Cipro for 10 days. That made him even more sick and eventually we visited another doc,. Pet scan/CT/ MRI was done… Turn out to be large gallstones that blocked everything. By then he lost 20+ lbs, severely anemic, liver and kidney function s were very bad and was unable to eat at all.
After 3 surgeries, he is now in recovery, last procedure was June this year. His hemaglobin improved from 7.7 in March, to 7.9 in April, and August 9.9….hematocrit from 25 in March, 26 in April, now 30.1 in August… Kidney creatinine from 2.34 in March, 2.1 in April , now August 1.8… they check epo protein in April, normal high,. Reticulocyte count in April, normal. Now liver function is completely normal. Blood pressure 140/72…oxyget 98, pulse 60, normal respiratory rate too. Normal iron study and normal b12 folate….mcv was 108 in April now 101 in August.. normal wbc, normal platelets, no immature granulocytes on differential. He eats well, feels good, exercise and travel like he always does with my mother.
This new family physician we are seeing in our hometown is concerned about anemia, but thinks it’s age related. He is ordering leukemia lymphoma blood smear profile. I am very scare and worry when hearing what is being tested when we are at the lab.
I am really sorry to bore you with all these details, just wondering if this sounds like a case of leukemia or lymphoma to you? Thanks for any input
Sorry but I really can’t weigh in on how concerned you should be about leukemia or lymphoma. Overall it sounds like his labs have improved quite a bit since March.
I would recommend asking the new doctor to clarify why he or she thinks a leukemia/lymphoma blood smear is indicated. You may want to ask what kinds of signs, symptoms, or lab abnormalities have raised the doctor’s concern for this?
It certainly can be scary to find out the doctors are checking for something that seems alarming. Hopefully the doctor will be able to clarify and perhaps reassure you. Good luck!
Hi this is franoh from india, my mother aged 55 she suffers with severe anemia for the past 3 years.
2 months once we used to do blood transfusion(but not always sometimes 6months once) for her and we have done all the test like cancer, hiv, mds..etc all the results where fine but the Doctor says her bone marrow is not generating blood because of anemic.
Is the severe anemic is curable and kindly let us know what are the steps to be taken to cure her.
Sorry but I’m unable to provide a second opinion regarding her anemia prognosis or what should be done. If the doctor says her bone marrow is not generating blood cells adequately, it might be helpful for you to ask the doctor to further explain why they think that is, what their plan is for investigating it, or how they think they can correct this problem. Good luck!
Hello. A couple of years ago I had a hgb of 11.5 and slightly low mcv. I am a man. The dr assumed Fe deficiency and prescribed Fe tablets. A few months later, my hgb was up to 16. He instructed me to take regular daily vitamins with Fe . So now my hgb is up to 17.1. My question : Once the anemia is resolved, will taking iron fortified regular vitamins continue to raise the hgb? My internal med dr says no. The polycythemia I have is not due to the extra small amount of daily iron.. but has another cause. Please what is your opinion?
I cannot really venture an opinion on your particular case. As far as I know, excess iron is not in of itself a cause of polycythemia. I will also share that in general, if a person does not have iron deficiency, then there is no reason to be taking iron supplements. Since you are not anemic, you may want to ask your doctor if it’s still advisable to take a vitamin containing iron.
My father in law has multiple health issues. After a fall he was sent from general hospital to a rehabilitation hospital. During this time he underwent a blood transfusion for anemia. He was sent to another nearby general hospital for the procedure on the Wednesday and transported back to rehabilitation (10 hours laterI believe). He was then discharged home -with a care package but without telling us – on the Friday i.e. Less than 48 hours after the procedure. He had been in hospital for over 10 weeks at this point. He said he felt awful – he was weak and disoriented. In response to my formal complaint the hospital apologised for not telling us they had sent him home. They said he was no longer anemic and was assessed to be fit for discharge. The date they sent him home was exactly 6 weeks from his date of entering rehabilitation. It is my feeling that this critical procedure should not have been subject to the rehabilitation time frame of 6 weeks and that he should not have been sent home when he was. He was back in general hospital 5 days later and is still there. We have been told to look for care homes. I appreciate you cannot comment on individual cases but I wondered if there are there recovery guidelines for an 81 year old man in chronic ill health following a blood transfusion? My gut tells me he was discharged too early but I do not have the knowledge to challenge this any further. Any help you might be able to offer is hugely appreciated.
Sorry to hear of your father in law’s difficulties. It sounds like the hospital did not do a very good job communicating with you, which is too bad.
Regarding recovery time, in an older person it would be driven less by the fact that he had a transfusion and much more by the reasons he needed a transfusion in the first place, which may or may not be the main reason he was hospitalized.
A transfusion usually improves the person’s blood count very quickly. Whether the blood count remains good depends on why it became low in the first place. This is part of why it’s important to ask doctors what they think caused the anemia, and what their plan is for followup.
You don’t say how old he is, but usually an older person is weak and disoriented after hospitalization because they have become deconditioned from being in bed (an aging body loses muscle strength very quickly), and also because older adults often become delirious in the hospital. Delirium is a very common state of worse than usual mental function that is brought on by illness or stress, I have more here: Hospital Delirium: What to know & do.
Whether a discharge is safe and appropriate usually depends on whether the person is medically stable (meaning, no longer in need of hospital level care and unlikely to become medically quite ill again without hospital supervision) AND can either manage basic home activities alone or has adequate support from family or others to help out.
Hope this helps. Good luck!
My 85 year old mother was hospitalized 2 weeks ago after a fall. She had a fall 6 days previous that nobody knew about because she didn’t tell anyone. It was determined in the hospital that she had an internal bleed. A colonoscopy and endoscopy showed nothing. They wanted to have her swallow a capsule with a camera on it, but my siblings and I agreed that would be a last resort. She received 4 bags of plasma and 2 bags of blood, and during the week she was there, her hemoglobin went up to 10.
She has been on Coumadin for 4 years because of 2 strokes and afib. In the hospital, she was off the Coumadin for 7 days, yet her INR was perfect. They resumed all of her meds, including coumadin, and sent her to a rehab facility. She has been there for 10 days, doing fairly well and gaining strength, but I received a call today that her hemoglobin was at 6.3 today and they were taking her to hospital for more blood.
I live 80 miles away, and have seen her several times since she’s been in rehab. She always says she feels fine, other than normal age-related aches and pains, and a tender knee where she fell, and is bored and tired of sitting around (she must have assistance when getting up, which she’s not used to) and anxious to get home.
My question is, could the coumadin and aspirin she takes daily be contributing to the undiagnosed bleed? Also, would the capsule camera be too much for someone her age? The doctor said it could get trapped and then require surgery. Thank you for any direction you can help us with!
Both warfarin (brand name Coumadin) and aspirin increase bleeding risk, and the bleeding risk is even higher when a person is taking both medications. They can either cause bleeding on their own, or if there is another cause for bleeding (e.g. a fall, an ulcer), they tend to make the bleeding worse than it otherwise would be.
If your mother has been experiencing bleeding, then it’s probably worth talking with her doctors and asking them to help you reconsider the likely benefits vs risks of continuing with the aspirin and warfarin. Right now she’s presumably at fairly high short-term risk of bleeding, whereas the absolute benefit of being on these preventive medications for the next few months might be smaller.
In the long run, I would be very careful about continuing someone her age on both aspirin and warfarin. Just being on warfarin provides some protection from recurrent stroke. Adding aspirin might provide a little extra protection but this may well be outweighed by the increased bleeding risk.
As for the capsule endoscopy, I don’t have much personal experience but according to my trusted clinical resource Uptodate.com, this is considered “very safe” and although the capsule is sometimes retained — usually in people who have abnormal intestines to begin with — this is not inherently very dangerous. So I am not sure why they are telling you this might require surgery, but it’s true that as a general rule, it’s a good idea to be cautious before carrying out a procedure on an older person.
In general, for any test — and any medication for that matter — you should ask the doctors to clarify what is the likely benefit and what are the likely risks. For a test, you should also ask how doing the test is likely to change management, and what is the downside to waiting or adopting a more conservative strategy.
Good luck, I hope her bleeding stabilizes soon.
Thank you so much!
My mother is 86 year old and recently been diagnosed as being anemic. Hemoglobin 10.3, Hematocrit 32.1, MCV91, Reticulocyte count 2.1% and Ferritin level 162 ng/mL. Her fecal occult blood test came back positive. We believe she may be bleeding from aspirin therapy (81mg daily). Six years ago she contacted west nile virus and suffered a stroke, but did not have any side affects from the stoke. She also has CCML. Dr’s started her on 45 mg of iron element, B12 and folic acid. She has stopped her aspirin therapy due to fecal occult blood test result. Question, will the bleeding stop once she stops taking aspirin? Should we take her for a colonoscopy? I think she is too old to get a colonoscopy. I’m not certain what steps we should take after a positive fecal occult blood test. Thank you so much for this web site, it is so informative and wonderful you are educating so many people. Thank you, Thank you, Thank you
Aspirin can be either a cause in of itself of bleeding or a contributor that makes bleeding persist or be worse than it otherwise would be. I can’t say which it’s likely to be in your mother’s case. Either way, aspirin’s effect in the body usually lasts for about a week.
I would recommend asking her doctors to discuss the likely benefits and risks of colonoscopy. Unless they think they are likely to find something that they can fix or intervene on, it’s often reasonable to give the person’s body time to resolve the bleeding, stop aspirin and other blood thinners, and see how things are.
Good luck and thank you for your kind words about the site, I appreciate it.
I am 74 years old and have been diagnosed with iron effeciency anemia. My regular doctor put me on iron pills and after three weeks there was no change. Since then I have been going to a Hemotologist and he put me on two iron pills a day. I just finished the f irst week. He doesn’t want to do the infusions because he said there is some risk involved. My biggest complaints are my painful legs and neck. Also everything that I eat has a nasty taste, not sure if this is related or not. I am to go back to him in one month but I don’t think that I can stand the pain until then. I can barely walk. Has anyone else ever complained of this problem. Thank you
Anemia in of itself is not usually associated with significant pain, nor are iron pills. If pain is an issue — and it sounds like it is — I would recommend asking your doctors to clarify what might be causing your pain. You might need further evaluation to address this.
Also as I note in the article, if you’ve been diagnosed with iron-deficiency anemia (generally this means you have a low ferritin or other laboratory signs of iron deficiency), I recommend asking the doctors to explain why you have become low on iron. This may or may not be related to the pain you are experiencing.
Good luck!
Hi Leslie,
Wow, you have many requests from all over the world to answer! Thank you for your time and generosity! We are grateful!
My 99 year old mother had a transfusion 2 years ago and her blood count is getting low again. She is not wanting to go to hospital for an intravenous supply of iron.
She is most uncomfortable with osteoarthritis, but increasing painkillers results in her having more falls, so it is a Catch 22 situation. The doctor doesn’t know what is causing the low iron. Her doctor is a very good doctor, but a man of few words.
What would be the likely outcome if she continues to refuse to go to hospital? Would it be likely that she would gently slip away? I obviously don’t want to see her suffer. I respect her wishes.
She is 99 and had a very energetic and long life. Her twin died 3 years ago of bowel cancer, had many transfusions despite her not wanting them and a painful ending. I don’t want my mother’s life to be prolonged and have to suffer unnecessarily. She is very Stoic but is battling with pain.
Thank you.
Thank you for your words of appreciation. Your mom’s situation is not uncommon, but that doesn’t make it easy. It sounds like she’s expressing reluctance to have more intensive medical management. Have you otherwise discussed goals of care with her, and what her priorities are? Doing so might help her and you find your way forward, and can also help the medical team better understand how to help her.
Palliative care specialists are particularly good at helping people with pain, and also with thinking through what matters most to them and what they want from their medical care. If you could get your mother to see someone in palliative care, that might help.
Get Palliative Care
For the most part, worsening anemia in someone who is older and frailer leads to fatigue and weakness, but not necessarily a lot of discomfort. Being weak and bedbound has downsides, but if she agrees to walk less, then treating her pain with medication may feel more feasible.
I hope you can get a palliative care consultation, that is often extremely helpful for these types of situations. Good luck!
My Mom is 81 years old and refuses to believe the doctor when she says that she has bleeding ulcers. Last week she let her hemoglobin levels fall below 37% before finally letting us drag her to the hospital for yet another transfusion.
She always says that the prescriptions the doctor gives her are too strong and cause bleeding, or constipation, or vomitting, or dizzyness and – rather than telling a pharmacist or doctor she just goes off her medications and uses herbal medicines that other elderly people say works for them. She also continues to take aspirins on a regular basis. Her feet are puffed up like balloons but she says that she needs different water pills like her sister has because the ones the doctor gives her are too strong. Even though she has decided that the water is needed to push her blood she says that she is tempted to prick her legs with a needle to let the water out. The doctor says her heart and kidneys are giving out because they have to work too hard and the blood is not getting to her extremities.
The most doctor at the ER explained to her that she is like a car without gas in the fuel lines and it is making her parts rusty but she just doesn’t seem to understand these analogies. She says “how can I be low on blood if my blood pressure is fine?”
I have tried to make and copy diagrams to show her why this is happening but we just can’t get through to her. Do you have any good ones or videos???? Help, help , help, she is driving us crazy. We all want to help her but feel like we are beating our heads against the wall.
Sorry to hear of your situation, it sounds very frustrating and I can see why you’d be very worried about your mother’s health.
For this kind of situation, my experience has been that more explaining basically doesn’t work, whether it’s from family or from the doctor. So I would stop trying to explain.
Either there is something medically wrong with her thinking, or she has her own beliefs and agenda and goals, and until those are heard and validated, she’s unlikely to feel motivated to change what she’s doing.
What CAN help is to ask her to tell you more about how she sees the situation. Even if her rationales are totally kooky (and that is useful to know, in terms of assessing her thinking abilities), once you know more about how she sees it and what is important, it becomes easier to propose things that might be amenable to her.
Also, people feel better about those who listen to them, and sometimes after they feel heard, older adults are more able or willing to go alone with something that has been suggested.
That said, many older adults persist in making choices that are very frightening to their families. If she has shown other signs of poor judgment or thinking problems (especially if it’s getting worse with time), then it can help to consider an evaluation for cognitive impairment. I explain what is involved here:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
Honestly these situations are very very difficult. You have to try to help, you have to accept that often they will refuse your help, you have to mostly respect their autonomy but somehow figure out when they really have lost capacity to decide and if that is the case, you have to figure out whether and how to intervene and override them. It is really difficult. I do have more on incapacity here:
Incompetence & Losing Capacity: Answers to 7 FAQs.
Last but not least, I would recommend joining a support group, for moral support and to get ideas. We are actually going to be launching a special community for people in your position soon, so stay tuned.
Do try to explain less and listen more. Good luck!
Hi, thanks for this detailed and informative article. My 82 yo mum’s haemoglobin level fell from 11.5 last year and to this year 10.8. However her ferritin level is above 700 which is very high. B12 and folate are normal. Does that mean she doesn’t have a deficiency type anemia? If so, what are the possible causes for her anemia?
Some background: She has a history of cancer (11 years ago) and a hernia in her abdomen. Meds she’s taking include plavix and omeprazole. She also suffered a serious fall two years back. No brain injury was detected then and her ultrasound scans and cancer marker blood tests seem fine.
Her doctor said to leave it because she’s old, but I’m just wondering if there’s anything I can do so that her anemia doesn’t get worse? She has lost weight and her joints are getting weaker by the day, possibly because of the high ferritin.
If her ferritin is high and her B12 and folate are normal, then a deficiency anemia sounds unlikely.
The article explains several other potential causes for anemia. If you’re concerned, I would recommend asking your mother’s doctors for more information about what they think is causing the anemia.
You may also want to ask her doctors how often they plan on checking her blood count, to make sure her anemia isn’t getting worse. A hemoglobin of 10.8 is not all that low; if it stays steady at that level, it may not be worth worrying too much about her anemia for now, but if it continues to drift down, then more evaluation may be in order. Good luck!
Hi Dr. I am a 54 year old woman who had a cbc ordered by my doctor after being checked for a muscle/nerve/ sciatic type injury… my hgb was 11.5, rbc 3.76 and hct 34.7. She did follow up for iron levels, b12 and pretty much everything else… all normal. She asked me if I noticed bleeding anywhere… I have not. She decided to redo all the blood work in a month. Should I be concerned?
A hemoglobin of 11.5 in a woman would normally be considered mild anemia, but as I explain the article, it is important to consider the context of the person’s health and the “trajectory” of these laboratory measurements.
I would recommend asking your doctor whether you should be concerned. You may also want to ask how the result results compare to your prior results. The doctor is planning to repeat your bloodwork; such monitoring is often a reasonable approach.
Hi I’m 39 and my anemia is acting up at very least… First and last episode was 6yrs blood transfusion and all also diabetic. So my hemoglobin is at 9… Feeling really tired take at least one nap a day… Would it be best to add b12 with irion pills?
I do take ibuprofen and pm version almost everyday… My work schedule is hectic so I am forced take… Might this be causing my anemia?
Ibuprofen can sometimes cause anemia if it causes stomach ulcers or other forms of bleeding in the gastrointestinal tract. I would recommend asking your usual health provider to help you determine whether this is likely to be a cause of your anemia.
As I explain in the article, the right treatment for anemia depends on what is causing the anemia. It would be pointless to add vitamin B12 or iron unless you were actually deficient in those substances. I would recommend talking to your usual health providers and asking them to help you understand what is causing your anemia. If they aren’t sure, then discuss what they are planning to do to figure it out.
Hello,
I am 47 with rheumatoid arthritis I have been anemic for most of my life . I yak e Ferrex for it. My lab results showed today that my homglobin is a 9.9 and a hematocrit of 29. I am scheduled for outpatient ostotomey on 4 toes this Friday. Everything I am reading is that surgery recovery isn’t good for patients who are anemic. But my surgeon says that’s it’s minimal blood loss and I should be fine. I’m conflicted as what to do now. Do you have any advice?
Thank you.
Sorry but no, the comments are mainly for me to clarify what I cover in my articles. You could try to find out more from the surgeons. Questions to consider include:
How important is it that you get the surgery? What are the consequences of delaying it? is it an option to try to improve your anemia prior to surgery?
Really before any procedure, you need to find out what are all your options and then you need to ask the involved health providers to clarify what are the likely benefits and risks of the various options.
You could also try getting a second opinion from another surgeon. Good luck!
For the past 8 months, my 76 year old relative has been experiencing all the anemia symptoms you list. She gets her blood checked every two weeks. When her hemoglobin falls below 8, she gets a transfusion. She then feels well for a few weeks until the cycle repeats itself. Her hemotologist has ruled out all the causes at this point, which I guess leaves us with unexplained anemia. She has had a bone marrow biopsy and that looked fine. Her iron levels are fine and recently high due to the transfusions. I don’t know all the tests they’ve done, but none has indicated a cause. Is that pretty much how it goes for unexplained anemia? Can one continue with tranfusions indefinitely? What kind of toll does this cycle take on the body? Does a cause sometimes appear over time? Do patients sometimes improve over time? Or is likely to get worse over time? Thank you–I haven’t been able to find many articles discussing the details of unexplained anemia.
Hm. Well, I would say it’s not uncommon for older adults to have unexplained anemia, but usually that anemia is actually fairly stable, so the older person has a lower hemoglobin count but it’s not chronically dropping and requiring transfusion.
For persisting anemia that keeps requiring a transfusion, it’s less common for it to be “unexplained” after evaluation by hematology. I would recommend asking the doctors more questions and asking them to clarify whether they think the problem is ongoing blood loss versus a problem making red blood cells or a problem maintaining them in the circulation.
You could also consider getting a second opinion, either from another hematologist (try one at an academic medical center) or by paying for a “second opinion” service from a major medical institution.
Chronic transfusions can lead to iron overload eventually. There may be other risks, the hematologist should be able to advise you. Good luck!
My father is 64 years old. He had viral and now his hb is decreasing. All the tests are coming normal. Earlier when he caught viral hb was 9 and its been more than a month now and hb is 6.9 now. Iron profile was done which is low and he is taking medicines for iron n folic acid. Still no improvement. Can you please suggest something
Hm, if his blood count keeps going down, I can certainly see why you’d be concerned. Unfortunately, I can’t really say what should be done, other than ask lots of questions. If he is low on iron, do they think he is losing blood from somewhere? What do they think is causing his anemia and what are they planning to do next, to figure it out or to treat him? Those are some of the questions you can consider asking.