Have you ever been told that an older relative has anemia, and wondered about anemia symptoms?
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 and diagnose 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.
Key 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 May 2024. (The fundamentals of anemia in older adults don’t change much over time.)
Bernadette S. Audije says
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.
Leslie Kernisan, MD MPH says
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!
M.Nazar Naseem says
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?
Leslie Kernisan, MD MPH says
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.
Gwen Herzog says
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
Leslie Kernisan, MD MPH says
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.
Rajat says
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?????
Leslie Kernisan, MD MPH says
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!
Stephen Simac says
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.
Leslie Kernisan, MD MPH says
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.
Gwen Herzog says
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
Leslie Kernisan, MD MPH says
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.
breda says
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.
Leslie Kernisan, MD MPH says
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!
John Miller says
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.
Leslie Kernisan, MD MPH says
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.
Benneth Tubana says
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).
Leslie Kernisan, MD MPH says
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!
Benneth Tubana says
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
Leslie Kernisan, MD MPH says
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
Rajat says
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
Leslie Kernisan, MD MPH says
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.
Julie says
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?
Leslie Kernisan, MD MPH says
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!
Ashw says
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
Leslie Kernisan, MD MPH says
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!
Keerthi says
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?
Leslie Kernisan, MD MPH says
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.