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Low Haemoglobin level, Anemia
C/O - Fatigue, weakness and virtigo
Patient age - 70+ yrs/Male
BP - Normal
Diabetes - under medication ( Tab Diamicron mr) Thyroid - under medication ( Eltroxin 50 )
Recently done CBC blood test shows that
Haemoglobin level is - 7.5 g/dl
RBC count - 2.68 m/c.mm
ESR - frst hr - 40 mm
Second hour - 67 mm
Rest of the report is normal.
No bleeding/ haematuria is noted.
Patient is presently taking,
Antioxidant capsules and Iron - Folic acid syrup( Dexorange syr).
How long does it take to recover the haemoglobin level to normal ? Does he need immediate blood transfusion? Or any other medicines... Please help.
Thanks in advance 🙏🏻
Answers (12)
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Considering his age, percentage of Hb and other elements you should consult physician immediately and in person.
He requires parental treatment..
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Need for blood transfusion can be delayed for time being. First need to know about the morphological type of anaemia. He must undergo CBC with PBF and iron profile followed by Bone Marrow examination( if need be) to rule out any haematological malignancy as RBC count is too low. Also need to go for colonoscopy to look for any GI malignancy as patient is anyway due for Colon screening at age of 70 yrs.
As patient is Diabetic , these symptoms could be explained by peripheral/ autonomic neuropathy.
Need to recheck his Thyroid profile to look if his dosage of thyroxine is adequate .
Would be worthwhile to know about the d blood glucose levels fasting & PP.
In d meantime for symptomatic relief patient can take
Tab. Betahistine 8 mg TID for dizziness
Tab. Pregastar M HS
Tab. Supradyn OD
continue other medications he already is on
NEEDS FEW MORE VISITS
Next Steps
Serum Iron profile
CBC with PBF
TSH
COLONOSCOPY
Health Tips
Normalisation of Hb levels will depend upon the etiology
NO URGENT NEED FOR BLOOD TRANSFUSION
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Kindly consult
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Low Hemoglobin needs extensive evaluation along with blood transfusion as of now.
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At this age with comorbidities and symptoms blood transfusion is advised oral supplements will take time and at this age he is also more prone to have cardiac complications so why to take risk but before that get iron profile and smear for type of anemia because some times at this age the anemia is dimorphic type so it will be easy for the treating physician to decide the further management.
Get live function and kidney function test also done.
Please take him to a general physician in your place for better evaluation and treatment.
Thankyou so much for the detailed case history.
Don't worry everything will be fine soon.
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Need further evaluation
Next Steps
consult
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Need to check vit b12 & iron level to know what is the reason for that
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Can help you with the next course of action and treatment plan. Would like to discuss in details and provide apt solution. Kindly consult.
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Needs injectables for Iron replacement.
Need to know the cause of Anemia
For which needs to be investigated.
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Dr. Saurabh Tripathi
General Physician
9 yrs exp
Kanpur
Kindly consult me for better evaluation
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Dr. Shodhan Aithal
Interventional Cardiologist
8 yrs exp
Mangalore
Blood transfusion is required if hb is below 7 or if he is having features of cardiac failure like breathlessness on exertion or leg swelling. So, he doesn't require blood transfusion. Iron deficiency is one of the common cause for anemia, but not the only cause. So I wouldbsuggest you to confirm iron deficiency by getting serum iron, tibc, ferritin and peripheral smear to confirm the iron deficiency. His iron requirement has to be calculated, for which body weight is required. Based on that, duration can be calculated. Also we need to evaluate for the cause of iron deficiency if proven. You consult me for detailed discussion. Right now, continue the ongoing supplementation and get the above mentioned evaluation done.
P.s I really appreciate the details of information given. Normally partial details are given. Good work there
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