Gradual Hemoglobin Decline: Causes and Concerns

Slow decrease in hemoglobin?

Hello Doctor: Two years ago, my hemoglobin was 14.8, and today it is 12.4.
Two months ago, during a routine health check, my hemoglobin was 12.6.
I have been eating less for lunch, and I wonder if this could be related to the decrease in hemoglobin.
Although it is still within the normal range, my hemoglobin has always been relatively high; last year, my gynecological exam showed it was over 13.
Is this rate of decrease normal? Today, I had additional tests to check for iron deficiency.
If there is no iron deficiency, what other reasons could there be for the gradual decrease in hemoglobin?

Vicky, 20~29 year old female. Ask Date: 2017/01/14

Dr. Hong Yuanbin reply Internal Medicine

Hello, a decrease in hemoglobin can be attributed to two possibilities: blood loss or reduced production.
Regarding blood loss, common sources include gastrointestinal bleeding or menstrual loss.
Therefore, I would like to ask if you have noticed any changes in your stool color recently, such as black stools or fresh blood in the stool.
If so, I recommend testing for occult blood in the stool or checking if there has been an increase in menstrual flow recently.

As for reduced production, consider whether you have been experiencing poor health, increased stress, or irregular sleep patterns lately.
I suggest maintaining a regular schedule and supplementing with vitamin B.
If the hemoglobin continues to decline, I recommend further blood tests or stool examinations.
Thank you for your inquiry.

Reply Date: 2017/01/14

More Info

The gradual decline in hemoglobin levels, as you've described, can be concerning, especially if you have previously maintained higher levels. Hemoglobin is a crucial protein in red blood cells that carries oxygen throughout the body, and its levels can be influenced by various factors, including diet, hydration status, and underlying health conditions.

Your recent hemoglobin levels of 14.8 two years ago, 12.6 two months ago, and now 12.4 indicate a downward trend, albeit still within the normal range for most laboratories. The normal range for hemoglobin can vary slightly depending on the lab, but generally, for women, it is approximately 12.0 to 15.5 grams per deciliter. While your levels are still considered normal, the decline may warrant further investigation, especially if you have noticed other symptoms or changes in your health.

Several factors could contribute to a gradual decline in hemoglobin levels:
1. Dietary Intake: You mentioned that your lunch portions are smaller. A diet low in iron, vitamin B12, or folate can lead to decreased hemoglobin production. Iron is particularly important, as it is a key component of hemoglobin. If your diet lacks these nutrients, it could explain the decline.
2. Hydration Status: Dehydration can falsely elevate hemoglobin levels, while overhydration can dilute hemoglobin levels. Ensure that you are adequately hydrated, as this can affect your readings.

3. Chronic Inflammation or Disease: Conditions such as chronic kidney disease, inflammatory diseases, or even certain cancers can lead to anemia or a gradual decline in hemoglobin levels. If you have any underlying health issues, it might be worth discussing these with your healthcare provider.

4. Menstrual Cycle: For women, menstrual blood loss can contribute to lower hemoglobin levels. If your menstrual cycle has changed or if you experience heavier periods, this could be a factor.

5. Bone Marrow Function: The bone marrow is responsible for producing red blood cells. Any condition that affects bone marrow function, such as aplastic anemia or other hematological disorders, could lead to a decrease in hemoglobin levels.

6. Medications: Certain medications can affect hemoglobin levels. If you are taking any medications, it may be worth reviewing them with your doctor.

Since you are undergoing additional testing to check for iron deficiency, this is a prudent step. If iron levels are normal, further tests may be needed to evaluate other potential causes of the decline. These could include tests for vitamin B12 and folate levels, reticulocyte count (to assess bone marrow response), and possibly a complete blood count (CBC) with differential to look for other abnormalities.

In summary, while your hemoglobin levels are still within the normal range, the gradual decline should be monitored. It is essential to maintain a balanced diet rich in iron and other vital nutrients, stay hydrated, and consult with your healthcare provider about any other symptoms or concerns. They may recommend further testing or dietary adjustments based on your overall health and lifestyle. Regular monitoring of your hemoglobin levels can help track any changes and guide appropriate interventions if necessary.

Similar Q&A

Understanding Low Hemoglobin Levels: Causes and Specialist Guidance

The health check report from my first year of high school indicates that my hemoglobin level is abnormally low. What effects could this have? If I need to see a doctor, which department should I visit?

Dr. Ke Zhengchang reply Internal Medicine
Dear Ms. Ruoye: There are many reasons for low hemoglobin levels, such as iron deficiency anemia, thalassemia, hemolytic anemia, and aplastic anemia, among others. It is recommended to visit a hospital and consult with a hematologist or oncologist for a detailed examination and t...

Understanding the Disappearance of Thalassemia in Recent Blood Tests

Hello Doctor: I recently underwent a physical examination for military service, and I have some questions. In the past, I was diagnosed with thalassemia minor, but my recent tests did not indicate any issues. What factors could affect the results and lead to a negative finding? H...

Dr. Hong Yuanbin reply Internal Medicine
Hello, 1. Mediterranean anemia requires further genetic testing to determine. The data you have is from a basic blood test, which can only indicate whether there is currently anemia. Based on this value, we can only say that there is no anemia at this moment; it does not rule o...

Understanding the Impact of Low Hemoglobin and Bruising in Family Medicine

1. A hemoglobin level of only 10.6 g/dL can lead to anemia, which may cause symptoms such as fatigue, weakness, shortness of breath, and dizziness. It can also affect the body's ability to transport oxygen effectively, potentially leading to complications if left untreated. ...

Dr. Li Yuqi reply Family Medicine
(1) The normal hemoglobin levels for women are 12 to 14 g/dL. If the level is 10.6 g/dL, it is essential to determine the underlying cause before assessing its impact on the body. (2) Easy bruising can have many causes, and it is important to seek medical attention to arrange for...

Understanding Low Hemoglobin: Causes and Solutions for Symptoms Like Dizziness and Fatigue

Hello, I would like to ask about my mother. Recently, she has been experiencing bloating, stomach pain, dizziness, headaches, blurred vision, general weakness, and loss of appetite. She was very uncomfortable, so in mid-May 2019, she went to the emergency room. The blood test res...

Dr. Xiao Yongxun reply Family Medicine
Dear Ms. Chen: 1. Based on your description, the management by various specialists appears to be reasonable and correct from a medical standpoint. 2. You may consider visiting a neurology outpatient clinic to rule out any neurological issues. If all tests are normal, it may be...