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.)
Angel says
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.
Leslie Kernisan, MD MPH says
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!
Kay says
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!
Leslie Kernisan, MD MPH says
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.
Ruth says
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.
Leslie Kernisan, MD MPH says
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.
Desmond says
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.
Leslie Kernisan, MD MPH says
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.
Desmond says
OK, Thank you.
Arsalan says
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?
Leslie Kernisan, MD MPH says
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.
Desmond says
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..
Leslie Kernisan, MD MPH says
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!
Desmond says
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!
Hip says
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
Leslie Kernisan, MD MPH says
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.
Peg Beatty says
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!!!
Leslie Kernisan, MD MPH says
Thank you for this comment. So glad you are finding this helpful. I would love for people to feel less “in the dark”!
Amandeep Singh says
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
Leslie Kernisan, MD MPH says
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!
Amandeep Singh says
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 ?
Leslie Kernisan, MD MPH says
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.
Beverly Lauder says
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.
Leslie Kernisan, MD MPH says
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!