# Low hemoglobin question



## Liz Wolf-Spada (Jul 15, 2009)

My hubby was just diagnosed with low hemoglobin (11). The doctor is repeating the test. He has been napping a lot and I've been concerned, but he retired in December, so I didn't know what to think. Should I be concerned about something serious? He's not a vegetarian or anything so he should be getting iron from his food, although it isn't in his mult-vitamin.
Liz


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## Rose Pink (Jul 15, 2009)

Consideration should be given to a slow bleed somewhere such as a digestive tract ulcer.  Another consideration is malabsorption of some kind such as Crohn's. There are many things that can cause low hemoglobin.  Does he also have a low hematocrit?  Are the red blood cells large?  What is his TIBC?  (total iron binding capacity).  His B12 level?  So many factors need to be considered before a diagnosis can be made.

I wouldn't recommend iron supplements for a man unless it can be shown he is iron deficient.  Too much iron can be deadly, too.

You need more information.


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## Bill4728 (Jul 16, 2009)

Men's hemoglobin (HGB)  should be about 14 -15 so he is low. BUT most Doctors worry when the HGB gets below 9.0 .( really concerned at 8.0) so he has a long ways to go before you start to worry.

PS he shouldn't be having any symptoms until his is under 10.


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## Larry6417 (Jul 16, 2009)

Bill4728 said:


> Men's hemoglobin (HGB)  should be about 14 -15 so he is low. BUT most Doctors worry when the HGB gets below 9.0 .( really concerned at 8.0) so he has a long ways to go before you start to worry.
> 
> PS he shouldn't be having any symptoms until his is under 10.



It's not possible to give clear advice without knowing all the facts, but I will tell you this: low hemoglobin is always abnormal and should be investigated, especially if your husband is elderly. Young, otherwise healthy people may not show symptoms until their hemoglobin is low BUT even they should be investigated for causes of anemia. The causes of anemia are varied; some causes can be relatively easily treated while other causes can be life-threatening. That's why your husband needs to be investigated. If the cause of anemia is minor then that would be great. If it's serious, then you can treat whatever the problem is early. The anemia itself may not always be a problem, but what's causing the anemia needs to be determined.


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## Liz Wolf-Spada (Jul 16, 2009)

Rose Pink, he doesn't have a clue about any of those other factors, but I did tell him to not add iron unless his doctor says he should. Thanks, everyone. He does take celebrex for arthritis so the possibility of digestive bleeding should be a concern, I would think.
Liz


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## normab (Jul 17, 2009)

A couple of years ago DH  (early 50s) had kidney stones that were causing a slow bleed (he didn't notice any blood in his urine) and he had low hemoglobin.  It took several doctors to figure out what the problem was.

My brother (in his late 30s) had dangerously low hemoglobin (under 6) and it ended up it was due to poor circulation.  This also took a long time to figure out. First they blamed his weight even though there was no bleeding seen.  He went for transfusions periodically for 2 years until he developed a sore that wouldn't heal on his leg.  That helped the doctor diagnose the circulation issue--which was the cause of the low readings.

It should be evaluated to find the cause--and it may take some time.


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## Liz Wolf-Spada (Jul 17, 2009)

Well, DH has a doctor's appt now on Tuesday, guess the new test results confirmed the low hemoglobin. I'm going with him so hopefully I can learn more then.
Liz


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## Redrosesix (Jul 17, 2009)

Low haemoglobin, iron deficiency, and anemia can be caused by so many different things, from something as simple as insufficient diet to something much more serious -- you really need to follow up with the doctors ASAP to find out why this is happening. A few years ago DH was diagnosed with multiple stomach ulcers as a result of a bacterial infection ie. as the doctor said, his stomach was bleeding like a sieve.  We wouldn't have known about it if it hadn't been for a low haemoglobin result.  However, the ulcers were not the first thing they suspected.

BTW, in kids, low haemoglobin may just be the result of growing -- as  their bones get longer and their bodies get bigger, it takes a while for enough bone marrow to be produced.  Fortunately, my uncle is a haemotologist, so when my DD went through this when she was 3 he knew what to look for to determine that it was something simple and not something serious.  In this case, iron supplements and time were sufficient to fix it.  Not necessarily a common cause -- just a coincidence that her blood happened to be tested at that time.

In both cases, there was no way of knowing what was causing it without further testing.


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## Larry6417 (Jul 18, 2009)

*Talk to your doctor!*

I'm a physician, and I'm very concerned about some of the medical information that is on this site. Some of the information is misleading or completely wrong. I've dealt with this sort of thing "offline" too. Information I give to relatives comes back to me from other relatives, who've heard what I said second or third hand. The information often comes back distorted or completely wrong. If there's any doubt, go right to the source; speak to the doctor with your loved one and ask questions.

Let me list the misconceptions I've found in this short thread. First, one post claimed that anemia doesn't cause symptoms until the Hgb is < 10. That depends on who has anemia. Young, otherwise healthy people may not have symptoms. However, older and less healthy people with COPD or coronary artery disease can definitely be affected by anemia before Hgb falls below 10. For example, those with coronary artery disease may experience angina. The same post claims that doctors don't worry about anemia until Hgb is less than 9. Not where I'm from! It's not just the anemia one has to be concerned about, it's whatever is causing the anemia. If the cause of anemia is determined and treated then physicians may not be worried enough to transfuse, but that's not the same thing as saying there's nothing to worry about.

Second, another post claimed that a loved one had anemia due to "poor circulation." There must be more to the story than that. "Poor circulation" is generally due to arterial insufficiency, which by itself doesn't cause anemia. There are rare causes of arterial insufficiency (some vasculitides) that can cause anemia, but, again, these are rare.

Third, another post implied that ulcers as a cause of anemia were not that common, not what physicians would think of initially. Actually, it's one of the first things physicians would consider. Iron deficiency is the most common cause of anemia in adults, and GI blood loss is the most common cause of iron deficiency (in the developed world). Ulcers are an extremely common cause of blood loss. The doctors may have been surprised at the number of ulcers; H. pylori (I assume that's the bacterial infection you're talking about) is quite common.

Fourth, the same post claimed that anemia was common in children. It is, but the most common cause is iron deficiency not physiologic causes. There's commonly anemia after birth (about 2 months) before the marrow starts to "kick in," but otherwise anemia in children would prompt at least a dietary history to look for iron deficiency.

Please don't misunderstand me. I'm not trying to embarrass or insult anyone (though I may have succeeded unintentionally  ). Speak directly to the source and ask questions for medical information. I think this site is wonderful for sharing moral support, but for goodness sake, don't take any of the medical advice here seriously without speaking to your healt care professional.


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## 3kids4me (Jul 18, 2009)

Larry, thank you for your thorough and informative post.  The fact that you took the time to do so no doubt reflects on your "in person" bedside manner as well as, of course, your knowledge as a physician.  I'll bet you have a very full practice!

Sharon


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## normab (Jul 18, 2009)

Thanks Larry for your pointers.   I think the main point we were making was that the situation needs to be evaluated further, supported by the examples we gave.

BTW, I am not embarrassed by my post if it there was some factual discrepancy.  My recall from 5 years ago is that the doctor said that the poor circulation meant that the blood was not making it back throughout the circulatory system, pooling in the legs, and therefore was not being oxygenated and that impacted the counts. (He was speaking in patient-speak.)  This may not be 100% correct since I have NO medical training whatsover and a 50+ year old memory, but I still stand by the ultimate recommendation to look into the situation further.


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## Larry6417 (Jul 18, 2009)

*Thanks for the replies.*

I agree about looking into the situation further. I was cautioning people to examine the medical advice they receive. Obviously, the average TUG user is more than intelligent enough to do that.


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## Redrosesix (Jul 19, 2009)

Larry6417 said:


> I'm a physician, and I'm very concerned about some of the medical information that is on this site. Some of the information is misleading or completely wrong. I've dealt with this sort of thing "offline" too. Information I give to relatives comes back to me from other relatives, who've heard what I said second or third hand. The information often comes back distorted or completely wrong. If there's any doubt, go right to the source; speak to the doctor with your loved one and ask questions.
> 
> Let me list the misconceptions I've found in this short thread. First, one post claimed that anemia doesn't cause symptoms until the Hgb is < 10. That depends on who has anemia. Young, otherwise healthy people may not have symptoms. However, older and less healthy people with COPD or coronary artery disease can definitely be affected by anemia before Hgb falls below 10. For example, those with coronary artery disease may experience angina. The same post claims that doctors don't worry about anemia until Hgb is less than 9. Not where I'm from! It's not just the anemia one has to be concerned about, it's whatever is causing the anemia. If the cause of anemia is determined and treated then physicians may not be worried enough to transfuse, but that's not the same thing as saying there's nothing to worry about.
> 
> ...



Not embarassed by your clarification -- I think the gist of my post was that anybody who is diagnosed with anemia, iron deficiency, low haemoglobin needs to have it looked into ASAP, and the only way the cause can be determined is with further testing.  I edited my post to make it more clear.

And yes, it was the H. pylori bacteria that got my DH, although the specialist said that he rarely sees a case that advanced.


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## dougp26364 (Jul 19, 2009)

A low hemoglobin alone means nothing. It could be as simple as being very well hydrated (fluid volume up) to many things more serious. A hemoglobin of 11, while low, isn't necessarily that uncommon and shouldn't be a major concern. It might prompt additional tests by your physician to rule out anything more serious but, it's not something I'd be worried about.


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