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.)
Franoh says
Hi this is franoh from india, my mother aged 55 she suffers with severe anemia for the past 3 years.
2 months once we used to do blood transfusion(but not always sometimes 6months once) for her and we have done all the test like cancer, hiv, mds..etc all the results where fine but the Doctor says her bone marrow is not generating blood because of anemic.
Is the severe anemic is curable and kindly let us know what are the steps to be taken to cure her.
Leslie Kernisan, MD MPH says
Sorry but I’m unable to provide a second opinion regarding her anemia prognosis or what should be done. If the doctor says her bone marrow is not generating blood cells adequately, it might be helpful for you to ask the doctor to further explain why they think that is, what their plan is for investigating it, or how they think they can correct this problem. Good luck!
Kelly says
Dear doctor, I am so happy to find your site. My father is 81, almost 82. Always had back pain, lower blood count and weak kidney function since 20 years ago. He had severe reaction to pneumonia vaccine over 15 years ago, and had bad allergies during allergy season. Beginning of this year back pain has gotten really bad eventually lead to loss appetite, mild fever, jaundice. Urgent care doc just did dipstick and sent us home with Cipro for 10 days. That made him even more sick and eventually we visited another doc,. Pet scan/CT/ MRI was done… Turn out to be large gallstones that blocked everything. By then he lost 20+ lbs, severely anemic, liver and kidney function s were very bad and was unable to eat at all.
After 3 surgeries, he is now in recovery, last procedure was June this year. His hemaglobin improved from 7.7 in March, to 7.9 in April, and August 9.9….hematocrit from 25 in March, 26 in April, now 30.1 in August… Kidney creatinine from 2.34 in March, 2.1 in April , now August 1.8… they check epo protein in April, normal high,. Reticulocyte count in April, normal. Now liver function is completely normal. Blood pressure 140/72…oxyget 98, pulse 60, normal respiratory rate too. Normal iron study and normal b12 folate….mcv was 108 in April now 101 in August.. normal wbc, normal platelets, no immature granulocytes on differential. He eats well, feels good, exercise and travel like he always does with my mother.
This new family physician we are seeing in our hometown is concerned about anemia, but thinks it’s age related. He is ordering leukemia lymphoma blood smear profile. I am very scare and worry when hearing what is being tested when we are at the lab.
I am really sorry to bore you with all these details, just wondering if this sounds like a case of leukemia or lymphoma to you? Thanks for any input
Leslie Kernisan, MD MPH says
Sorry but I really can’t weigh in on how concerned you should be about leukemia or lymphoma. Overall it sounds like his labs have improved quite a bit since March.
I would recommend asking the new doctor to clarify why he or she thinks a leukemia/lymphoma blood smear is indicated. You may want to ask what kinds of signs, symptoms, or lab abnormalities have raised the doctor’s concern for this?
It certainly can be scary to find out the doctors are checking for something that seems alarming. Hopefully the doctor will be able to clarify and perhaps reassure you. Good luck!
Anne says
Hi, I appreciate your posted info on low hemoglobin. I have been battling with very low hemoglobin for the past 5 years now. I was just hospitalized for 15 days from it. My doctors can’t seem to find the answer to my problem. I have had many tests such as CT Scans, MRI, Bloodwork, lower Gi and upper Gi where they used a scope to see inside my large intestine and lungs, I have been hospitalized many times to only find nothing wrong. I crave ice, my arms and legs feel very heavy, my heart races when I do things, when especially climbing stairs. I have really bad headaches with no energy. My b12 is good and I am taking liquid iron that’s all natural and it doesn’t make me sick. I’m tired of having outpatient IV’s to get iron or blood transfusions. I really need to find out the cause so that my problems can hopefully be corrected if possible. Right now my quality of life is far from where it should be. Any advice?
Leslie Kernisan, MD MPH says
Sorry to hear of your persisting anemia. Craving ice or other non-food items is called pica. This symptom has a known association with iron deficiency, although it may also be associated with other micronutrient deficiencies, such as zinc deficiency:
A meta-analysis of pica and micronutrient status
Hard to say why your doctors haven’t yet found a cause. Presumably, they have done an adequate first pass evaluation and are not overlooking anything obvious. So it might be something more unusual that is causing your anemia. You could try getting a second opinion, if you haven’t already done so. You may want to consider contacting a specialty academic center, as they are sometimes better able to figure out “medical mysteries” that have stumped other clinicians. You could either look for someone specializing in refractory iron-deficiency anemia, or try the “Second Opinion” services available at some of the top level academic medical centers, such as this service at UCSF: UCSF Health Second Opinion.
You could also try using a service such as PatientsLikeMe or SmartPatients to find other people with a similar “hard to explain” anemia. Sorry I don’t have an easier answer for you, unfortunately the answer is usually to ask more questions or find someone else to ask. Good luck!
Richard says
Hi Doctor.
54 y.o. man here. Generally healthy in every other aspects. Non smoker for 2 years now, drink 2-3 glasses of wine a day, excercise regularly. That said I’ve consistently had low red blood cell counts for the last few years but seems stable (4.5 ish), Hematocrit at 0.40 and Hemo at 135.
As mentionned, it appears to be stable for the last couple of years (since I started taking regular tests). Otherwise, I do feel a little less vitalized than I used to but always thought it was just aging.
Should this be of any concern? Is a lower-than-average type of condition sometimes ”just ther way I am made”?
Leslie Kernisan, MD MPH says
I don’t think I’d describe the numbers you share for hematocrit and hemoglobin as low, they are on the lower side of what’s often described as the normal range but that’s usually ok. Also reassuring that your counts have been stable. This could indeed be “the way you are made” but of course it’s impossible for me to rule out some other cause or factor that is making your count a little lower than it otherwise would be.
As to your feeling less energetic than before: hard to say whether this is “just aging” or not. There are actually many different things that can cause a person to feel less energetic at your age.
I doubt it’s your low-normal blood count but there are many other possibilities that are fairly common in your age group. I would recommend talking with your usual health provider. They should ask more questions to see what other symptoms or problems you are having, they should do a physical exam, and they might order additional bloodwork or studies, depending on what you’ve been checked for in the past and your personal medical history. good luck!
Jane Walker says
Hello Dr. Kernisan,
I’ve suffered from heavy menses since I was 10 years old and would have to change pads every hour, but every month on time and lasting exactly 7 days. When I reached 40 I started wearing depends because of the heavy flow. I am now 45 yrs, but the last year my cycle has been unpredictable; one month not coming at all, the next month lasting weeks, the next month very light. At 39 I had a blood transfusion which required 5 bags of blood because I was told the heavy flow was due to me having fibroids and needed to have an operation to get them removed. Does that mean I had fibroids at 10 years old too when my cycle began and my flow was just as heavy? I decided not to have the surgery. However, I have had many blood transfusions since then because I am told my heavy menses causes me to have severe anemia with blood counts as low as 4.9 (December 2017) but never higher than 8. The transfusions make me feel better but I just bleed it out in 1-3 months. I’ve opted to stop getting the transfusions (my blood count now is 6.5, August 2018) due to the risks of transfused blood. Since 2014 I’ve had many seizures and faintings And I was diagnosed with epilepsy. As time goes on, I can’t remember most things, I don’t want to do anything other than be by myself, I’m cranky and irritated most of the time, I’m sore and out of breath, I have anxiety, the list goes on. I’ve been told to eat healthier but I’m wondering is this because of me getting older? Please advise and thanks for your advice…your website is very helpful and informative!!! 🙂
Leslie Kernisan, MD MPH says
Sorry to hear of all these health concerns you’ve had to deal with. You are 45 and it sounds like your anemia is very much related to these gynecological issues. I can’t answer your questions, I would recommend you find a good gynecologist, perhaps one who specializes in treating patients with unusually heavy menses and/or fibroids. Good luck!
carol haff says
Hi, I have been feeling bad lately, low energy no get up & go, blood tests have been ok but still have energy problems. I am 75 year old female. I do take 500mg b12 & 100mg b6 once daily. along with b complex. could I be low on iron, would that show up on blood test, or should I increase my b12. I’m use to being very active, but don’t have much energy lately. By the way, I took a prolia shot 6 months ago for osteoporosis & have been feeling bad ever since. I’m due another one in a week but don’t think I’ll take it. I mentioned this to my Dr. she said it wasn’t the prolia. what do you think. Thanks so much.
Leslie Kernisan, MD MPH says
Sorry to hear about your low energy. Yes, anemia is a possibility, and it could be due to low iron or due to any number of other causes.
But there are also plenty of non-anemia medical reasons for a person your age to feel low on energy.
Really what you need to do is see a health provider and ask to be evaluated for your low energy. Normally they will ask questions to see if you have any other particular symptoms that might point to the cause of your low energy, they’ll do a physical exam, and then in most cases they will order a blood count but also a metabolic panel and possibly other blood tests. I cover commonly ordered blood tests here: Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
In terms of whether it might be the Prolia: that’s a much newer medication for osteoporosis, I don’t have much personal experience with it and generally the difficulty with newer medications is that side-effects aren’t well known. That particular medication is not recommended as first-line treatment in Uptodate because of this, and also because the bones start weakening again fairly quickly if one doesn’t continue it (whereas this is not really an issue with bisphosphonates, which are usually first-line treatment). In short, there are more downsides with you deciding to not take your next Prolia dose than there would be with stopping many other types of medication.
I would recommend talking to your doctor about your fatigue, and also about the pros/cons of continuing Prolia. You could also consider asking her if it’s possible to postpone the Prolia for at least a few weeks while you get evaluated for fatigue. Good luck!
Mark Richardson says
Dr. Kernisan,
In the last year my Hb has dropped from around 13-14 to the 9-10 range. I am a 69 yr. old male and feel fine not noticing any of the side effects of being anemic. I exercise around four hours per week along with working outside in the yard without any excess fatigue.
About a month ago I mentioned to my regular doctor during a six month check up that the last few times I attempted to give blood I was turned away because of low Hb levels down to 11 two months ago.
My doctor’s routine fasting lab test prior to the visit did not include Hb thus a second lab test was run to determine my Hb level. Then a follow up stool test was positive.
He thus ordered colonoscopy and upper endoscopy. Before those tests occurred, he arranged an appointment with an oncologist which I saw today. The oncologist cancelled both the mentioned tests and arranged a bone marrow aspiration and biopsy.
I noticed above you suggested a peripheral smear was typically done prior to the bone marrow test. Is there a down side to not doing the smear test first and skipping the scope tests?
Thank you very much.
Leslie Kernisan, MD MPH says
A peripheral smear is often done before a bone marrow biopsy because a peripheral smear is fairly easy on the patient; the blood is collected via an ordinary draw. Whereas a bone marrow biopsy is more of an undertaking. If a peripheral smear shows cells that are abnormally shaped, or otherwise suggest a problem with the bone marrow, then there is more of a justification for putting a person through a bone marrow biopsy. (Getting a sample of bone marrow takes more work than getting a sample of blood.)
It’s impossible to say whether there is a downside to skipping a certain type of test. Whether a test is likely to help depends on what else is already known about the patient, and what the clinicians are now trying to figure out. Perhaps your ferritin was normal and you had no signs of iron-deficiency, despite developing anemia.
I would recommend you ask your health providers to explain why they think it’s best to cancel your endoscopy (which is also not a trivial procedure) and instead proceed to bone marrow biopsy. Good luck!
Mark Richardson says
Thank you for the information. I guess the upside of the bone marrow test is that likely more information will be gleaned than with a peripheral smear. Will the bone marrow test determine if the blood cells that are abnormally shaped?
I will certainly followup on cancelling the endoscopy since the stool test is positive. The oncologist simply said that since my last endoscopy was only two years ago there was no point in doing one this soon. Does that logic make any sense?
Thanks again.
Leslie Kernisan, MD MPH says
The shape of cells in your blood can be seen on a peripheral smear. A bone marrow biopsy allows them to see the shape of the precursor cells that are in the bone marrow, and also will allow them to see if there’s anything else unusual in the marrow itself, such as surprisingly large (or small) numbers of certain types of cells, etc.
Endoscopy is actually often reasonable after a positive stool test, because the endoscopy helps clinicians figuring out just where in the bowel the bleeding is coming from, and what is causing it (e.g. an ulcer? a polyp? an inflammatory condition of the bowel lining?). Generally the type of colonic polyps that can bleed or become cancerous take more than 2 years to emerge, so that may be why the oncologist feels this test is unlikely to be useful. However, if there’s a possibility that you have an ulcer or something that’s not a polyp, and if it seems like you are still bleeding from inside your GI tract, then endoscopy might make more sense.
In short, whether it makes sense to proceed with a test — or cancel it — depends on a lot of things. The most important thing for you to do is ask a lot of questions of your doctors, to understand why they are proceeding in a certain matter. Good luck!
Richard Kahn says
I am 87 years old and my hemoglobin has been steadily declining. It recently fell from10.2 to 9.8 and my hematologist has put me on weekly injections of Procrit. The result has been an almost constant state of exhaustion. My iron and B-12 levels are normal. Do you have any suggestions? Thanks.
Leslie Kernisan, MD MPH says
A hemoglobin change from 10.2 to 9.8 is pretty small, both are close to 10. Now, 10 is not considered normal, that is what we’d usually consider moderate anemia, and of course must be considered in light of what your hemoglobin has been in the past and the rest of your medical history.
I can’t make any suggestions re treatment. I would recommend that you ask more questions in order to better understand what your doctor thinks is causing your anemia, and what their plans are for further evaluation. You may want to ask what other tests they’ve done so far. If Procrit doesn’t help you feel better and doesn’t improve your blood count, then you may want to ask them whether they think you should continue and if so, why.
Good luck!
JEAN ROBOR says
My 92-year-old mother is in a facility for rehab and possibly will go into skilled nursing. For almost two weeks they have been doing blood draws that show her Hematocrit at 21 and 22 and her Hemoglobin at 7.2-7.4. I’m not sure why a plan of action has not been formulated to correct this. Is it normal to wait that long? In the past she has had blood transfusions, larger doses of iron and B-12 shots for low Hemoglobin. I’ve spoken to the nurse who just says the doctor has not ordered any changes yet. Any advice?
Leslie Kernisan, MD MPH says
It’s hard for me to say whether what they are doing is “normal” or not. You say she’s had transfusions and iron therapy in the past, so it sounds like she has a prior history of anemia. Her recent hematocrit of 21 may or may not be due to the same cause.
I would mainly recommend you ask the doctors a lot of questions, so that you can better understand what is going on. First of all, I would recommend asking them to clarify what was the cause of her prior anemia, and then I would recommend asking whether her more recent anemia seems to be due to the same cause or not. If they aren’t sure what is the cause, ask what they plan to do to figure this out. And then of course, ask them what their plan is for monitoring and correcting her current anemia.
You may also want to discuss the goals of her medical care with them. At age 92, some older adults — or their families — have opted for less intensive medical treatment. How aggressively they monitor and manage her anemia may depend on what they think are her priorities and goals, when it comes to her medical care. Good luck!
Jim Ahles says
I just found out two weeks ago that my hemoglobin level is 7.0. I have blood work regularly as I am a diabetic and four months ago all was normal. Just had a colonoscopy and endoscopy and nothing found. Doc said all other counts are normal. I am being referred to a hematologist and have started iron supplements. I’m 65.
Should I be asking my doctor or the specialist about the ferratin level? I feel I want answers quickly but not really getting them. Should I ask for a cat scan orsone other cancer test? I’m a bit concerned as this has really slowed me down. I’m a software developer and getting so fatiuged is concerning.
By the way, I found the article and your responses very informative!
Leslie Kernisan, MD MPH says
Glad you found the article helpful.
Hm, a hemoglobin of 7 is not trivially low. I would encourage you to ask your doctor more questions about what kinds of tests they have done to determine the underlying cause. I do think it would be reasonable to ask if they checked the ferritin, and why they are having you try iron.
The hematologist may be able to advise as to whether you’re likely to benefit from CAT scans. Good luck!