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.)
Ana says
Hi I’m 39 and my anemia is acting up at very least… First and last episode was 6yrs blood transfusion and all also diabetic. So my hemoglobin is at 9… Feeling really tired take at least one nap a day… Would it be best to add b12 with irion pills?
Ana says
I do take ibuprofen and pm version almost everyday… My work schedule is hectic so I am forced take… Might this be causing my anemia?
Leslie Kernisan, MD MPH says
Ibuprofen can sometimes cause anemia if it causes stomach ulcers or other forms of bleeding in the gastrointestinal tract. I would recommend asking your usual health provider to help you determine whether this is likely to be a cause of your anemia.
Leslie Kernisan, MD MPH says
As I explain in the article, the right treatment for anemia depends on what is causing the anemia. It would be pointless to add vitamin B12 or iron unless you were actually deficient in those substances. I would recommend talking to your usual health providers and asking them to help you understand what is causing your anemia. If they aren’t sure, then discuss what they are planning to do to figure it out.
A Reed says
Hi Dr. I am a 54 year old woman who had a cbc ordered by my doctor after being checked for a muscle/nerve/ sciatic type injury… my hgb was 11.5, rbc 3.76 and hct 34.7. She did follow up for iron levels, b12 and pretty much everything else… all normal. She asked me if I noticed bleeding anywhere… I have not. She decided to redo all the blood work in a month. Should I be concerned?
Leslie Kernisan, MD MPH says
A hemoglobin of 11.5 in a woman would normally be considered mild anemia, but as I explain the article, it is important to consider the context of the person’s health and the “trajectory” of these laboratory measurements.
I would recommend asking your doctor whether you should be concerned. You may also want to ask how the result results compare to your prior results. The doctor is planning to repeat your bloodwork; such monitoring is often a reasonable approach.
Catherine says
Hi, thanks for this detailed and informative article. My 82 yo mum’s haemoglobin level fell from 11.5 last year and to this year 10.8. However her ferritin level is above 700 which is very high. B12 and folate are normal. Does that mean she doesn’t have a deficiency type anemia? If so, what are the possible causes for her anemia?
Some background: She has a history of cancer (11 years ago) and a hernia in her abdomen. Meds she’s taking include plavix and omeprazole. She also suffered a serious fall two years back. No brain injury was detected then and her ultrasound scans and cancer marker blood tests seem fine.
Her doctor said to leave it because she’s old, but I’m just wondering if there’s anything I can do so that her anemia doesn’t get worse? She has lost weight and her joints are getting weaker by the day, possibly because of the high ferritin.
Leslie Kernisan, MD MPH says
If her ferritin is high and her B12 and folate are normal, then a deficiency anemia sounds unlikely.
The article explains several other potential causes for anemia. If you’re concerned, I would recommend asking your mother’s doctors for more information about what they think is causing the anemia.
You may also want to ask her doctors how often they plan on checking her blood count, to make sure her anemia isn’t getting worse. A hemoglobin of 10.8 is not all that low; if it stays steady at that level, it may not be worth worrying too much about her anemia for now, but if it continues to drift down, then more evaluation may be in order. Good luck!
Sharon Deceuninck says
My Mom is 81 years old and refuses to believe the doctor when she says that she has bleeding ulcers. Last week she let her hemoglobin levels fall below 37% before finally letting us drag her to the hospital for yet another transfusion.
She always says that the prescriptions the doctor gives her are too strong and cause bleeding, or constipation, or vomitting, or dizzyness and – rather than telling a pharmacist or doctor she just goes off her medications and uses herbal medicines that other elderly people say works for them. She also continues to take aspirins on a regular basis. Her feet are puffed up like balloons but she says that she needs different water pills like her sister has because the ones the doctor gives her are too strong. Even though she has decided that the water is needed to push her blood she says that she is tempted to prick her legs with a needle to let the water out. The doctor says her heart and kidneys are giving out because they have to work too hard and the blood is not getting to her extremities.
The most doctor at the ER explained to her that she is like a car without gas in the fuel lines and it is making her parts rusty but she just doesn’t seem to understand these analogies. She says “how can I be low on blood if my blood pressure is fine?”
I have tried to make and copy diagrams to show her why this is happening but we just can’t get through to her. Do you have any good ones or videos???? Help, help , help, she is driving us crazy. We all want to help her but feel like we are beating our heads against the wall.
Leslie Kernisan, MD MPH says
Sorry to hear of your situation, it sounds very frustrating and I can see why you’d be very worried about your mother’s health.
For this kind of situation, my experience has been that more explaining basically doesn’t work, whether it’s from family or from the doctor. So I would stop trying to explain.
Either there is something medically wrong with her thinking, or she has her own beliefs and agenda and goals, and until those are heard and validated, she’s unlikely to feel motivated to change what she’s doing.
What CAN help is to ask her to tell you more about how she sees the situation. Even if her rationales are totally kooky (and that is useful to know, in terms of assessing her thinking abilities), once you know more about how she sees it and what is important, it becomes easier to propose things that might be amenable to her.
Also, people feel better about those who listen to them, and sometimes after they feel heard, older adults are more able or willing to go alone with something that has been suggested.
That said, many older adults persist in making choices that are very frightening to their families. If she has shown other signs of poor judgment or thinking problems (especially if it’s getting worse with time), then it can help to consider an evaluation for cognitive impairment. I explain what is involved here:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
Honestly these situations are very very difficult. You have to try to help, you have to accept that often they will refuse your help, you have to mostly respect their autonomy but somehow figure out when they really have lost capacity to decide and if that is the case, you have to figure out whether and how to intervene and override them. It is really difficult. I do have more on incapacity here:
Incompetence & Losing Capacity: Answers to 7 FAQs.
Last but not least, I would recommend joining a support group, for moral support and to get ideas. We are actually going to be launching a special community for people in your position soon, so stay tuned.
Do try to explain less and listen more. Good luck!
Debbie says
Hi Leslie,
Wow, you have many requests from all over the world to answer! Thank you for your time and generosity! We are grateful!
My 99 year old mother had a transfusion 2 years ago and her blood count is getting low again. She is not wanting to go to hospital for an intravenous supply of iron.
She is most uncomfortable with osteoarthritis, but increasing painkillers results in her having more falls, so it is a Catch 22 situation. The doctor doesn’t know what is causing the low iron. Her doctor is a very good doctor, but a man of few words.
What would be the likely outcome if she continues to refuse to go to hospital? Would it be likely that she would gently slip away? I obviously don’t want to see her suffer. I respect her wishes.
She is 99 and had a very energetic and long life. Her twin died 3 years ago of bowel cancer, had many transfusions despite her not wanting them and a painful ending. I don’t want my mother’s life to be prolonged and have to suffer unnecessarily. She is very Stoic but is battling with pain.
Thank you.
Leslie Kernisan, MD MPH says
Thank you for your words of appreciation. Your mom’s situation is not uncommon, but that doesn’t make it easy. It sounds like she’s expressing reluctance to have more intensive medical management. Have you otherwise discussed goals of care with her, and what her priorities are? Doing so might help her and you find your way forward, and can also help the medical team better understand how to help her.
Palliative care specialists are particularly good at helping people with pain, and also with thinking through what matters most to them and what they want from their medical care. If you could get your mother to see someone in palliative care, that might help.
Get Palliative Care
For the most part, worsening anemia in someone who is older and frailer leads to fatigue and weakness, but not necessarily a lot of discomfort. Being weak and bedbound has downsides, but if she agrees to walk less, then treating her pain with medication may feel more feasible.
I hope you can get a palliative care consultation, that is often extremely helpful for these types of situations. Good luck!
martha Ruddick says
I am 74 years old and have been diagnosed with iron effeciency anemia. My regular doctor put me on iron pills and after three weeks there was no change. Since then I have been going to a Hemotologist and he put me on two iron pills a day. I just finished the f irst week. He doesn’t want to do the infusions because he said there is some risk involved. My biggest complaints are my painful legs and neck. Also everything that I eat has a nasty taste, not sure if this is related or not. I am to go back to him in one month but I don’t think that I can stand the pain until then. I can barely walk. Has anyone else ever complained of this problem. Thank you
Leslie Kernisan, MD MPH says
Anemia in of itself is not usually associated with significant pain, nor are iron pills. If pain is an issue — and it sounds like it is — I would recommend asking your doctors to clarify what might be causing your pain. You might need further evaluation to address this.
Also as I note in the article, if you’ve been diagnosed with iron-deficiency anemia (generally this means you have a low ferritin or other laboratory signs of iron deficiency), I recommend asking the doctors to explain why you have become low on iron. This may or may not be related to the pain you are experiencing.
Good luck!
Helen Delgado says
My mother is 86 year old and recently been diagnosed as being anemic. Hemoglobin 10.3, Hematocrit 32.1, MCV91, Reticulocyte count 2.1% and Ferritin level 162 ng/mL. Her fecal occult blood test came back positive. We believe she may be bleeding from aspirin therapy (81mg daily). Six years ago she contacted west nile virus and suffered a stroke, but did not have any side affects from the stoke. She also has CCML. Dr’s started her on 45 mg of iron element, B12 and folic acid. She has stopped her aspirin therapy due to fecal occult blood test result. Question, will the bleeding stop once she stops taking aspirin? Should we take her for a colonoscopy? I think she is too old to get a colonoscopy. I’m not certain what steps we should take after a positive fecal occult blood test. Thank you so much for this web site, it is so informative and wonderful you are educating so many people. Thank you, Thank you, Thank you
Leslie Kernisan, MD MPH says
Aspirin can be either a cause in of itself of bleeding or a contributor that makes bleeding persist or be worse than it otherwise would be. I can’t say which it’s likely to be in your mother’s case. Either way, aspirin’s effect in the body usually lasts for about a week.
I would recommend asking her doctors to discuss the likely benefits and risks of colonoscopy. Unless they think they are likely to find something that they can fix or intervene on, it’s often reasonable to give the person’s body time to resolve the bleeding, stop aspirin and other blood thinners, and see how things are.
Good luck and thank you for your kind words about the site, I appreciate it.
Sandy says
My 85 year old mother was hospitalized 2 weeks ago after a fall. She had a fall 6 days previous that nobody knew about because she didn’t tell anyone. It was determined in the hospital that she had an internal bleed. A colonoscopy and endoscopy showed nothing. They wanted to have her swallow a capsule with a camera on it, but my siblings and I agreed that would be a last resort. She received 4 bags of plasma and 2 bags of blood, and during the week she was there, her hemoglobin went up to 10.
She has been on Coumadin for 4 years because of 2 strokes and afib. In the hospital, she was off the Coumadin for 7 days, yet her INR was perfect. They resumed all of her meds, including coumadin, and sent her to a rehab facility. She has been there for 10 days, doing fairly well and gaining strength, but I received a call today that her hemoglobin was at 6.3 today and they were taking her to hospital for more blood.
I live 80 miles away, and have seen her several times since she’s been in rehab. She always says she feels fine, other than normal age-related aches and pains, and a tender knee where she fell, and is bored and tired of sitting around (she must have assistance when getting up, which she’s not used to) and anxious to get home.
My question is, could the coumadin and aspirin she takes daily be contributing to the undiagnosed bleed? Also, would the capsule camera be too much for someone her age? The doctor said it could get trapped and then require surgery. Thank you for any direction you can help us with!
Leslie Kernisan, MD MPH says
Both warfarin (brand name Coumadin) and aspirin increase bleeding risk, and the bleeding risk is even higher when a person is taking both medications. They can either cause bleeding on their own, or if there is another cause for bleeding (e.g. a fall, an ulcer), they tend to make the bleeding worse than it otherwise would be.
If your mother has been experiencing bleeding, then it’s probably worth talking with her doctors and asking them to help you reconsider the likely benefits vs risks of continuing with the aspirin and warfarin. Right now she’s presumably at fairly high short-term risk of bleeding, whereas the absolute benefit of being on these preventive medications for the next few months might be smaller.
In the long run, I would be very careful about continuing someone her age on both aspirin and warfarin. Just being on warfarin provides some protection from recurrent stroke. Adding aspirin might provide a little extra protection but this may well be outweighed by the increased bleeding risk.
As for the capsule endoscopy, I don’t have much personal experience but according to my trusted clinical resource Uptodate.com, this is considered “very safe” and although the capsule is sometimes retained — usually in people who have abnormal intestines to begin with — this is not inherently very dangerous. So I am not sure why they are telling you this might require surgery, but it’s true that as a general rule, it’s a good idea to be cautious before carrying out a procedure on an older person.
In general, for any test — and any medication for that matter — you should ask the doctors to clarify what is the likely benefit and what are the likely risks. For a test, you should also ask how doing the test is likely to change management, and what is the downside to waiting or adopting a more conservative strategy.
Good luck, I hope her bleeding stabilizes soon.
Sandy says
Thank you so much!
Vanessa says
My father in law has multiple health issues. After a fall he was sent from general hospital to a rehabilitation hospital. During this time he underwent a blood transfusion for anemia. He was sent to another nearby general hospital for the procedure on the Wednesday and transported back to rehabilitation (10 hours laterI believe). He was then discharged home -with a care package but without telling us – on the Friday i.e. Less than 48 hours after the procedure. He had been in hospital for over 10 weeks at this point. He said he felt awful – he was weak and disoriented. In response to my formal complaint the hospital apologised for not telling us they had sent him home. They said he was no longer anemic and was assessed to be fit for discharge. The date they sent him home was exactly 6 weeks from his date of entering rehabilitation. It is my feeling that this critical procedure should not have been subject to the rehabilitation time frame of 6 weeks and that he should not have been sent home when he was. He was back in general hospital 5 days later and is still there. We have been told to look for care homes. I appreciate you cannot comment on individual cases but I wondered if there are there recovery guidelines for an 81 year old man in chronic ill health following a blood transfusion? My gut tells me he was discharged too early but I do not have the knowledge to challenge this any further. Any help you might be able to offer is hugely appreciated.
Leslie Kernisan, MD MPH says
Sorry to hear of your father in law’s difficulties. It sounds like the hospital did not do a very good job communicating with you, which is too bad.
Regarding recovery time, in an older person it would be driven less by the fact that he had a transfusion and much more by the reasons he needed a transfusion in the first place, which may or may not be the main reason he was hospitalized.
A transfusion usually improves the person’s blood count very quickly. Whether the blood count remains good depends on why it became low in the first place. This is part of why it’s important to ask doctors what they think caused the anemia, and what their plan is for followup.
You don’t say how old he is, but usually an older person is weak and disoriented after hospitalization because they have become deconditioned from being in bed (an aging body loses muscle strength very quickly), and also because older adults often become delirious in the hospital. Delirium is a very common state of worse than usual mental function that is brought on by illness or stress, I have more here: Hospital Delirium: What to know & do.
Whether a discharge is safe and appropriate usually depends on whether the person is medically stable (meaning, no longer in need of hospital level care and unlikely to become medically quite ill again without hospital supervision) AND can either manage basic home activities alone or has adequate support from family or others to help out.
Hope this helps. Good luck!
Robert Morgan says
Hello. A couple of years ago I had a hgb of 11.5 and slightly low mcv. I am a man. The dr assumed Fe deficiency and prescribed Fe tablets. A few months later, my hgb was up to 16. He instructed me to take regular daily vitamins with Fe . So now my hgb is up to 17.1. My question : Once the anemia is resolved, will taking iron fortified regular vitamins continue to raise the hgb? My internal med dr says no. The polycythemia I have is not due to the extra small amount of daily iron.. but has another cause. Please what is your opinion?
Leslie Kernisan, MD MPH says
I cannot really venture an opinion on your particular case. As far as I know, excess iron is not in of itself a cause of polycythemia. I will also share that in general, if a person does not have iron deficiency, then there is no reason to be taking iron supplements. Since you are not anemic, you may want to ask your doctor if it’s still advisable to take a vitamin containing iron.