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.)
Don Goodenough says
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.
Leslie Kernisan, MD MPH says
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!
Maureen says
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.
Leslie Kernisan, MD MPH says
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!
Laura Moran Walton says
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.
Leslie Kernisan, MD MPH says
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!
Sofia says
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.
Leslie Kernisan, MD MPH says
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!
tracy says
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.
Leslie Kernisan, MD MPH says
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.
Mary says
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.
Leslie Kernisan, MD MPH says
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.
Debi Collins says
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.
Leslie Kernisan, MD MPH says
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!
ERuby says
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
Leslie Kernisan, MD MPH says
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!
Tanya says
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
Leslie Kernisan, MD MPH says
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!
Margaret Gregg says
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 ?
Leslie Kernisan, MD MPH says
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!
Miguel says
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 ?
Leslie Kernisan, MD MPH says
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!
Jijo Arjun says
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
Leslie Kernisan, MD MPH says
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!
soumya says
Is hb 10.3 very low for 27 year women? I am having 10.3 hb.
Leslie Kernisan, MD MPH says
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!