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What Causes Low Hemoglobin Level?

Posted on Mon, 14 Apr 2014

Question: Hi, my dad has had low rbc, hemoglobin, and hematocrit for about 3 months now (after several blood tests) but his doctor kept saying its fine. My dad is constantly tired and has low energy. He has been tested for sleep apnea and is being treated. He has low testerone which is being treated. The doctor gave him iron pills to take just because we asked. His levels for the past 3 months have been: Rbc - 3.91, 3.76, 3.88 Hemoglobin - 12.4, 12.2, 12.6 Hematocrit - 38.2, 36.2, 37.1 Another doctor said he could possibly be bleeding inside? Is this XXXXXXX and should we get him to er? He doesn't have any symptoms of light headed XXXXXXX or dizziness or shortness of breath. He says he feels fine other than being exhausted and wanting to sleep all the time. Please help. I'm so worried for him and he's also getting frustrated. My dad is 79 years old and has stage 3 kidney disease but he goes to his kidney doctor every 3 months and he says he's doing we'll. thank you.

Answered by Dr. T Shobha Deepak (1 hour later)

Brief Answer: To rule out occult gastrointestinal bleeding Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Dear Ms XXXXXXX I understand your concern and apprehension regarding your father's health. His Hemoglobin is on the lower side, but not very low. It could possibly be due to Chronic Renal disease. Kidney secrete Hormone known as Erythropoetin which stimulates Red blood cell(RBC) and help in synthesis by acting on precursor cells in bone marrow. Individuals with chronic renal disease could have low hematocrit and hemoglobin level due to low Erythropoetin level. Other possible cause that needs to considered is occult(internal) Gastro-intestinal bleeding. Gross bleeding in gastrointestinal tract will cause stools to be tarry black and some alteration in stool color. There may be minor gastro-intestinal complaints. If the bleeding is small in quantity and of longer duration it may not cause discoloration of stools, but will definitely cause low hemoglobin. I would suggest you to get Stool examination done specifically looking for Occult blood in stools, in consultation with your Physician. If its negative , there is no cause for concern. Do write to me if you need any further assistance. Wishing you and your family great health Take Care Best regards Dr T Shobha Deepak MBBS,MD

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Shobha Deepak (15 minutes later)

Thank you doctor. I forgot to mention that my dad did do an occult stool sample test and it was negative. Could he be bleeding inside like the other doctor indicated? If so is this really dangerous? Just trying to figure out why he's so tired all the time and treat this. It's affecting his daily life. Also the doctor have him iron pills to take but other tests show he's not low in iron? Could a lot of iron be bad for him? Thanks

Answered by Dr. T Shobha Deepak (1 hour later)

Brief Answer: Oral Iron will not cause Iron Overload Detailed Answer: Hi Greetings, Oral Iron intake is safe and is unlikely to cause Iron overload. When the Iron stores of the body is replenished, the oral absorption decreases. I would advise you to repeat occult blood examination report on two different occasion as there may be intermittent bleeding. Also if there is further drop in Hemoglobin in spite of being on Hematinics, it will definitely be indication for further intervention. Take Care Best regards Dr T Shobha

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Shobha Deepak (34 hours later)

Thank you doctor. Is there anything that can be done regarding his exhaustion and always being tired? Could this be dangerous? He just did a occult stool test in February. 3 of the levels just started in January. Blood test in OCT 2013 showed only low rbc. Thanks

Answered by Dr. T Shobha Deepak (12 hours later)

Brief Answer: Hematinics and Multivitamin to be started Detailed Answer: Greetings Dear Ms XXXXXXX I would suggest you the following steps 1. Hematinics and Multivitamin: As they will help replenish his Iron stores and elevate Hemoglobin they will make him feel better. 2. Ensure good intake of water : 2 to 3 liter of water per day. 3. High fiber diet 4. Consume sufficient salt in diet 5. Regular exercise : 30 minutes of brisk walking everyday is the best exercise. It releases endorphins which are naturally occurring analgesic like substance present in body which help in restoring good feeling and energy levels. 6. 2 serving of vegetable salad a day 7. Two serving of fresh fruits everyday 8. Meditation/ Yoga I am sure these measures will be beneficial Do get back to me if you need any further assistance. Take care Best Regards Dr T Shobha Deepak MBBS, MD

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar