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.)
Jeffrey Goh says
Dear Leslie Kernisan
Need your good advice urgently.
My mom is 88 years old, she has been diagnosed with low blood count, about 8 points and also irregular heart beat. Few days ago she had a mild heart attack.
Heart doctor wanting to give blood thinner to her but worry she might have internal bleeding that causes her anemia. We are reluctant to do colonoscopy given her age.
To us, currently she looks pretty fine except a bit weak. She can sleep and eat and doesn’t look like there is any internal bleeding.
What’s your take on this?
Thanks in advance.
Leslie Kernisan, MD MPH says
Taking a blood thinner does increase the risk of internal bleeding, or can worsen an existing small bleed. Is there a very big and important benefit in taking the blood thinner right away? (This is the kind of question you need to ask her doctors; I cannot answer it because it depends on her particular health circumstances.)
If not, then it may make sense to wait a bit and try to find out why she became so anemic. Your doctors should be able to tell you whether a colonoscopy is likely to be very risky given her age and condition. There are also other ways to check for internal bleeding. Last but not least, waiting for a period of time and seeing if the blood count stabilizes is another potential approach that can be used. good luck!
Jeffrey Goh says
Thanks for your advice. Pls let me know what other ways to check for internal bleeding? The doctor’s said that’s the only way and every operations carry certain risk.
The blood thinner is to prevent her from having heart attack or stroke which according to the doctor, is about 15 to 20% yearly.
Leslie Kernisan, MD MPH says
They should be able to test her stool to see if there are signs of microscopic blood. Also, you can ask whether her ferritin was low, or did she have other signs of iron loss.
Re the blood thinner, atrial fibrillation in of itself increases stroke risk, there are calculators available online, a commonly used scoring system is called “CHA₂DS₂-VASc.” Usually in people your mother’s age, their stroke risk is 5-12%/year. She will also be at risk for a heart attack but that is fairly high in everyone her age, especially if they’ve previously had one related to a coronary artery getting blocked.
It often does make sense for older adults with afib to take blood thinners; whether the likely benefits of her starting one right away outweigh the risks , compared to perhaps waiting a few weeks; this is one thing you might discuss with her doctors.
Dave says
I’m deeply concerned about my partner, she’s 33 years old, mother to my three children. She’s had a consistently low white and red cell count for nearly three years (Since our youngest was born), initially the doctors were not concerned, they’d say it was probably related to a virus, send her away for a month and repeat bloods, this went on for 18 months or so before they finally agreed to send all the results to Haematology. They said a three month course of iron tablets for Normocytic anaemia should sort her out, and it did, bloods back to within normal range and all she felt better in herself, less lethargic, picking up less colds etc.
After the course of iron tablets they gradually returned to her abnormal ‘normal count’, around 3.4 for WBC and yet again they send her away and repeat bloods in a month, ad infinitum.
At what point do we push this? Or push in the extreme, i’ve tried everything I can to push our GP to look into it further or just give us an answer as to what she think the underlying cause is and why she doesn;t seemed concerned in the slightest! It can’t be normal and i’m deeply concerned there is something sinister going on.
Kind regards.
Leslie Kernisan, MD MPH says
Well, I can’t really say at what point you should push or anything like that. Her WBC count is borderline low, so it may or may not be of significance.
What is more interesting to me is that you say her blood count got better with iron supplements. So, you may want to ask them if she had signs of iron deficiency (e.g. was a ferritin checked) when they decided to prescribe iron, and have any of those signs come back? If she is iron-deficient now, the question would be why.
Otherwise, it’s certainly too bad that the GP seems unable or unwilling to tell you what she thinks is going on. If you are concerned and the GP doesn’t seem to be helpful, then you may want to consider a second opinion with a hematologist. Good luck!
Waad says
Ihave my homglobiean 10,6 is this bad sm woman 38 year
Leslie Kernisan, MD MPH says
A hemoglobin of 10.6 is generally considered low for a woman, and would be consistent with anemia. As I explain in the article, it’s important to consider whether it’s a chronic problem or new issue, and how quickly the hemoglobin level seems to be changing. Your health providers should be able to help you with an evaluation and an explanation.
Lesley says
This has been the most helpful article I have come across in my search for answers to my anaemia! I have been suffering for at least five years and unable to get my levels up. Living in Greece is not easy and much research is done on our part.
My latest readings are haematocrit 33,1, RCC 3700000, haemoglobin 10,5, serum iron 61 and ferritin 14,5. The doctor has prescribed ferrous glutonate but should I be pushing for a colonoscopy and endoscopy? Any advice would be greatly appreciated
Leslie Kernisan, MD MPH says
Glad you found the article helpful.
Well, the main thing I recommend pushing for is an explanation. If your doctor thinks you are low on iron, ask him/her to explain what is the likely cause, and does it seem to be ongoing?
The other thing to consider would be whether you are due/eligible for colon cancer screening for other reasons. Good luck!
Martin fennell says
Hi. 95 year old mother, currently in a nursing home. Eats very little, aenimic,angina problems. Haemoglobin drops every few months. She gets blood transfusion. Question. Why would they let it drop to 6, before deciding she needs a transfusion. Ie, if it’s at 7, they won.t do a transfusion.
Leslie Kernisan, MD MPH says
Hm, well I would recommend you ask the involved providers to explain their reasoning for why they wait until a hemoglobin of 6 rather than 7. Some research (generally done in hospitalized patients, not nursing home patients) suggests a transfusion threshold of 7 is acceptable, so perhaps they are waiting for her to drop just below 7 (e.g. 6.8)?
I hope they have explained to you why she has these persisting drops in hemoglobin. If not, I would recommend asking questions as this sounds like an important issue to address. Good luck!
Judy Fenton says
Will read more of this excellent site before asking about possible reasons for low haemoglobin. Then will go back to my ( new) GP and possibly ask questions of my gastroenterologist who wants me to have a colonoscopy. My age 84 and live entirely alone. Thanks, Judy.
Leslie Kernisan, MD MPH says
I’m so glad to know you’ve found this article helpful, in learning about what questions you might ask.
Generally, when considering a colonoscopy or other procedure, it’s a good idea to ask the doctors to specify how they think it’s likely to help, and what the risks are.
I would also recommend going to your medical appointments with a family member or trusted friend. No matter what age one is, it’s a good idea to have someone else there to take notes and help you keep track of what the health providers say. Also good to start “grooming” someone to be a back up who can assist with your health, as many older people will eventually need this type of help (and it’s hard to predict just when the need will arise).
Good luck and take care!
Aaron Giladi says
Im 65 and diabetic (A1c around 6.1-6.6) – in May 2017 A1c at 7.4 – went on low/no carb diet and gym routine – nxt A1c on August 2017 at 5,9 – fantastic but HGb and HCt dropped from a constant 14.4 and 42/44 range (since 2005) to 12.8-13.1 and 38 to 40 range – has been this way to date – all other CBC tests spot on – Dr. not that concerned but sent me for Colonoscopy which was perfect. So my question is
1. Something changed after weight loss – and no matter what I eat im at a solid 150lbs (was at 163) any clue
2, Shoulder replacement required – started advil around may timefram – could that be a problem
3. How far can they take this testing – sounds like an endless process
4. Would all my other CBC results be normal if there was an issue?
Thank you
Leslie Kernisan, MD MPH says
Advil does cause some microscopic bleeding in some people, so it’s plausible that this might contribute to a lower red blood cell count. A colonoscopy inspects the colon but not the small bowel or stomach, both of which can be sources of bleeding. If there is a slow chronic bleed, often other tests related to iron-deficiency anemia (e.g. ferritin) are abnormal, but the white blood cell count and platelet count can still be normal.
The testing can indeed go on for a long time…which is why sometimes it’s reasonable to give the situation time and monitor for a bit.
Be sure to keep asking your doctors lots of questions, they are best positioned to help you figure this out.
Good luck!
Khan says
Great site! You can explain so well.!
I am interested in mild anemia and came across your site. I am 45 Male and I noticed lower HGB 13.1 and RBC 4.36 and HCT 40.0 in a report in nov 2017. I had been having symptoms of a headache after exercise or exertion. However, a blood retest in Jan2018 revealed levels are back to normal but in the starting range, 4.5 13.7, 41.2 The iron was perfect so no iron deficiency. The doctors say that anemia is not there. But I still have symptoms, tension headaches on exertion, an irregular heartbeat at times. Does these reading sound like mild anemia?
i lost weight from 2012-2016 now at 50kg underweight at 170cm. Noticed that blood pressure has lowered from 140/80 to 116/ 70 and lower resting pulse at 50 from 60. So not sure if these are symptoms of underweight or something else. I also noticed blood in stools for the past 2 years. But cannot be sure if it was blood. the fecal occult was negative.
I have anxiety and the doctors are not able to isolate the issue. I am concerned about any advice from you would help.
Leslie Kernisan, MD MPH says
I think it’s unlikely that your symptoms are due to anemia. If they are persisting, then you should definitely keep working with your doctors to figure out what is causing your symptoms. If you have noticed an irregular heartbeat at times, you should be sure to mention this to your doctors. There are usually ways to monitor the heart for several days (via a wearable patch or other special device); something like this could help determine what is going on with your heart when you experience symptoms. Good luck.
Khan says
Thanks for the advice. I Have been seeing different specialty doctors but they have not been able to pont the finger to any one cause for the headaches . I have done done holter and all other heart related tests. They are fine. Only minor jha plaque in artery.
I was more concerned if there is any Undetected cancer (colon) that is had caused the weight loss . And is beginning to show some symtomps .
Is there anything that I need to look i need to look Out for ?
Leslie Kernisan, MD MPH says
If you are concerned about undetected cancer, then I would recommend bringing that up with your usual doctors. They would be best positioned to advise you on how to address this concern, and what might be signs of cancer given your situation.
Unintended weight loss certainly is a concerning symptom, however, if your weight has stabilized since 2016, that sounds somewhat reassuring. Of course, if you are experiencing worrisome symptoms, then you need to keep asking your health providers for help, or consider seeing a different type of doctor. There are a certain number of people who have symptoms for years and are “medical mysteries,” but some doctors are particularly good at working through those cases. In the US, some clinicians in functional medicine have had good success in evaluating these cases, because they have a more careful and thorough approach than conventional doctors do. Good luck!
khan says
Thanks for your input Dr. Leslie. Do you know of any good functional medicine doctors in the US that i can reach out to that can help.
Leslie Kernisan, MD MPH says
I would recommend searching on google and asking around in your local area.
Karlee Conforti says
Hello,
My father who is 57 went for an annual physical in the beginning of January. He is about 220 lbs and 5’7″. He was diagnosed with Type II Diabetes. They also did blood work which showed iron deficiency. He has been feeling more tired recently, especially when he exercises, and he has a history of blood in his stool, but he said he hasn’t had this in months. He went for a colonoscopy in his 40’s for blood in his stool and they said it was due to fissures, so he always thought maybe it was due to that.
The CBC results:
Hgb 13.2
HCT 39.2
MCH 27.0
MCHC 33.7
MCV 80.0
RDW 13.9
Iron studies results:
Ferritin 11
Iron 48
Iron saturation 11
Iron binding capacity unsaturated 387
Iron binding capacity 435
After these results, he was placed on an iron supplement.
He went for a colonoscopy which found a 2 cm benign polyp, diverticulosis, and internal hemorrhoids.
The doctor is also referring him for an upper endoscopy.
I was just wondering your thoughts on these blood results. I am a PA student and I have learned to be worried about anemia in males, because it is usually due to something more sinister.
Is it possible that the anemia can be due to benign causes? He does have a history of taking Naproxen Sodium regularly. Is it possible he can have an asymptomatic bleeding stomach ulcer?
Sorry for the novel. I just get nervous. Especially because my uncle had anemia and was ultimately diagnosed with pancreatic cancer (not related by blood to my father).
What steps do you think we should be taking? Or are we on the right path?
Thank you,
Karlee
Leslie Kernisan, MD MPH says
His anemia isn’t that bad but his ferritin level and iron studies certainly seem consistent with iron deficiency. The evaluation he’s been getting sounds reasonable.
Personally I don’t consider bleeding due to chronic naproxen use “benign,” although it’s generally less worrisome than cancer. Yes, he could certainly have an ulcer or bleeding from somewhere else in his GI tract.
It is possible to have iron-deficiency anemia and also a cancer, but I think in most situations like the one you describe, it’s usually just some slow bleeding somewhere (that is not caused by cancer).
If you’re concerned about something potentially more serious, I would encourage you to bring it up with the doctor, and also keep an eye on weight and other symptoms over the next few months. Good luck!
Karlee says
Hello,
My dad had repeat blood work after being on the iron pill once a day for about 3 months (he took the pill with meals, which he was unaware that it is better absorbed on an empty stomach). The results were:
RBC 4.94
Hgb 13.5
Hit 40.2
MCV 81.4
RDW 14.7
Iron 57
Ferritin 8.5
All labs went up but the ferritin went down. He was also placed on an 81 mg aspirin daily at this time. He just received an upper endoscopy which showed no evidence of a bleed. They are going to do a heme occult stool test and if that is positive, they’re going to do the capsule endoscopy of the small bowel. If it is negative, they are going to continue supplementation and monitor. We are also waiting for the results of the biopsies taken from the endoscopy.
My question is if you think this is a reasonable course to go? Could the aspirin been effecting these numbers? He stopped taking naproxen so the only NSAID he’s been on is the aspirin.
Is there anything else we should test? So confused as to why he is iron deficient and so nervous that we may be missing something.
Leslie Kernisan, MD MPH says
I really can’t say whether they might be missing something. (It’s always a possibility.) His blood count overall is not that low, but his ferritin does seem quite low.
You may want to ask them to discuss with you the likely benefits and risks of taking the aspirin at this time. It is a risk for new or continued bleeding, so it might help for the doctors to clarify how important it is for him to take it at this time.
Vanessa says
Hi Dr. Kernisan,
I have been researching my symptoms and issues for a few weeks now and came across this publication. You truly seem to care, I’m seeing that you comment back to so many people and I seem to be in a situation where, since all of my blood work came back in the “normal” range, my doctor said I just have anxiety and insomnia. I beg to differ. I have never felt this way and wanted to share a couple numbers with you to seek advice.
I am 33 years old, very active, work full time, and raise two children. About a month ago, I started getting what I call head flutters, just odd sensations that would come and go throughout the day in my head, but no pain. About a week later, I then started feeling brain fog, wasn’t focusing as much at work, just feeling off, fatigued, not sleeping, I wake up every night in the middle of the night. I then started feeling chest pressure, my chest just feels heavy.
I started looking over my results myself to see if anything showed any clues and saw a couple numbers that were borderline low normal so I wondered if maybe I could be borderline anemic? Is it okay to take an iron supplement to see if it helps? I have no energy and I was going to the gym 3 or 4 days a week and now I don’t feel like going at all (I’m 5’6″, 125 lbs). I appreciate any feedback. The last time I called my doc’s office they just told me if I feel terrible, go to the ER. Here are the numbers that leaned towards the lower area of normal:
RBC 4.28
Hemoglobin 13.5
MCHC 33.7
Alkaline Phosphate 36
Everything else was pretty much right in the middle, thyroid was definitely high normal though! They did not check my Vit D or check on the B12 or ferritin. I’m just tired of feeling like this!
Leslie Kernisan, MD MPH says
Sorry that you’ve been feeling unwell. I don’t evaluate or treat people your age, but I do know it’s not uncommon for formerly healthy people to develop symptoms but be told that everything appears normal by the doctor.
It’s always important to rule out truly dangerous things first. Chest discomfort can be caused by a lot of things. It’s uncommon for active women of your age to develop heart problems but not unheard of, and heart disease is often overlooked in women. If the pain gets worse or scary, obviously you should call 911. Otherwise, you may want to ask the doctor if there is any possibility your symptoms could reflect heart problems, or some other issue affecting blood vessels (e.g. autoimmune disease).
Otherwise, there is certainly a phenomenon in which a formerly healthy person who starts to feel unwell, experiences a variety of non-specific symptoms, but the labs come back normal, and the docs conclude that it’s in their head, or it’s depression, or it’s anxiety, or it’s too much stress at work, and so forth. These have sometimes been called “functional somatic syndromes.” They are probably related to a complicated interplay between a person genetics and body, environmental factors, and lifestyle factors.
Conventionally trained doctors working in conventionally managed practices often have difficulty helping people in such situations.
There is a new-ish approach in healthcare that seems more successful in helping people who are “medical mysteries,” it’s called functional medicine. The Cleveland Clinic has some information about this approach here: https://my.clevelandclinic.org/departments/functional-medicine/about
From what you shared, seems to me very unlikely that anemia or borderline anemia would be the cause of your symptoms. Generally it’s not a good idea to take an iron supplement unless one has a proven iron-deficiency (e.g. a low ferritin level).
If your symptoms persist, you will have to keep asking for help from medical providers. If your usual provider is not helpful, you will need to look into a second opinion, or perhaps a consultation with a provider who specializes in cases similar to yours. Functional medicine may well help. Good luck!