Decreased Hemoglobin and Hematocrit Levels: Causes and Solutions

Decreased hemoglobin and hematocrit levels?

Hello, doctor.
Last week, I underwent an adult health check and blood tests, and compared to two years ago, my hemoglobin, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin have all decreased significantly.

In 2015 (full body health check):
- Hemoglobin: 11.5 g/dL
- Hematocrit: 35.1%
- Mean Corpuscular Volume: 84.2 fL
- Mean Corpuscular Hemoglobin: 27.6 pg
- Neutrophils: 75.8%
- Lymphocytes: 17.2%
In 2017 (adult health check):
- Hemoglobin: 10.4 g/dL
- Hematocrit: 32.1%
- Mean Corpuscular Volume: 75.9 fL
- Mean Corpuscular Hemoglobin: 24.6 pg
The outpatient doctor suggested that I might have thalassemia based on the 2017 report, although my parents do not have this condition.
I also experience heavy menstrual bleeding, averaging around 120-140 mL per month (using a tampon that absorbs 15g of fluid).
During my menstrual cycle, I often feel dizzy, have headaches, and experience lower back pain.
This month, it has been severe enough to cause frontal headaches and dizziness for nearly two weeks.
However, the clinic doctor said it is unrelated to the heavy menstrual bleeding and advised me to take iron supplements to improve my condition.
I would like to ask if the decrease in my blood parameters could be related to my shift to night shifts and sleep disturbances (taking 1-2 hours to fall asleep each time).
Additionally, the family medicine doctor did not explain the two abnormalities at that time, and I would like to inquire about their potential causes.
I have been experiencing insomnia for nearly two weeks, difficulty falling asleep, and my body tends to be easily stressed, leading to endocrine imbalances, along with headaches and nausea.
I apologize for the many questions, but I have researched and still do not fully understand the possible causes to make improvements.
I have to undergo another test in three months and am worried that my levels will continue to decrease.

A Cha, 20~29 year old female. Ask Date: 2017/11/22

Dr. Huang Xunying reply Family Medicine

In addition to Mediterranean anemia, you may also have concurrent iron deficiency anemia.
If you are experiencing symptoms, it is advisable to consume other iron-rich foods in addition to apples.
Regarding the white blood cells, if there are only abnormalities in the differential count and the total white blood cell count is normal, it may indicate an asymptomatic infection at the time of the blood test.
If there are no subsequent symptoms such as fever, you should follow the follow-up schedule arranged by your physician.
However, if you feel worse before your follow-up appointment, it is recommended to return to the clinic earlier, as heavy menstrual bleeding may exacerbate anemia.
Additionally, if you are experiencing heavy menstrual bleeding, it is advisable to consult a gynecologist.

Reply Date: 2017/11/22

More Info

Understanding decreased hemoglobin (Hb) and hematocrit (Hct) levels is crucial for identifying potential health issues and implementing appropriate interventions. Based on your recent health check results, where your hemoglobin dropped from 11.5 g/dL to 10.4 g/dL and hematocrit from 35.1% to 32.1%, it is important to explore the possible causes and solutions.

Causes of Decreased Hemoglobin and Hematocrit
1. Iron Deficiency Anemia: This is one of the most common causes of low hemoglobin levels. It can result from inadequate dietary intake, chronic blood loss (such as heavy menstrual periods), or malabsorption issues. Given your mention of heavy menstrual bleeding, this could be a significant factor.

2. Chronic Disease: Conditions such as chronic kidney disease, inflammatory diseases, or malignancies can lead to anemia of chronic disease, where the body does not produce enough red blood cells despite having adequate iron stores.

3. Bone Marrow Disorders: Disorders affecting the bone marrow, such as aplastic anemia or malignancies like leukemia, can impair red blood cell production.

4. Vitamin Deficiencies: Deficiencies in vitamin B12 or folate can also lead to decreased hemoglobin levels, as these vitamins are essential for red blood cell production.

5. Lifestyle Factors: Your shift to night work and associated sleep disturbances may contribute to fatigue and stress, which can indirectly affect your hemoglobin levels. Chronic stress can lead to hormonal imbalances that may impact red blood cell production.

Symptoms and Impact
The symptoms you describe, including dizziness, headaches, and back pain, can be associated with anemia. Low hemoglobin levels mean that your body may not be receiving enough oxygen, leading to fatigue and other systemic symptoms. Heavy menstrual bleeding can exacerbate this condition, leading to further drops in hemoglobin and hematocrit levels.

Solutions and Management
1. Dietary Adjustments: Increasing your intake of iron-rich foods (such as red meat, beans, lentils, and leafy greens) can help improve your iron levels. Pairing these with vitamin C-rich foods (like citrus fruits) can enhance iron absorption.

2. Iron Supplements: If dietary changes are insufficient, your doctor may recommend iron supplements. It's important to follow your healthcare provider's guidance on dosage and duration.

3. Menstrual Management: If heavy menstrual bleeding is a significant issue, discussing options with a gynecologist may be beneficial. Treatments may include hormonal therapies or other interventions to reduce menstrual flow.

4. Sleep Hygiene: Improving your sleep environment and establishing a regular sleep schedule can help mitigate the effects of night shifts and improve overall health. Techniques such as relaxation exercises, avoiding caffeine before bed, and creating a dark, quiet sleeping environment may help.

5. Regular Monitoring: Since you mentioned the need for follow-up tests in three months, it’s crucial to keep track of your hemoglobin and hematocrit levels. Regular blood tests can help monitor your progress and adjust treatment as necessary.

6. Stress Management: Addressing stress through mindfulness, therapy, or physical activity can also have a positive impact on your overall health and may help regulate hormonal levels that affect blood production.

Conclusion
In summary, decreased hemoglobin and hematocrit levels can stem from various causes, including iron deficiency, chronic diseases, and lifestyle factors. Given your symptoms and health history, it is essential to work closely with your healthcare provider to identify the underlying cause and develop a tailored management plan. By addressing dietary needs, menstrual health, sleep quality, and stress levels, you can improve your hemoglobin and overall well-being. Regular follow-ups will be key to ensuring that your levels stabilize and that any underlying issues are effectively managed.

Similar Q&A

Understanding Decreased Hemoglobin and Hematocrit Levels: Causes and Solutions

Hello doctor, two years ago my blood test showed only a slightly low hemoglobin level of 11.5 g/dL, with a hematocrit of 35.1%, mean corpuscular volume (MCV) of 84.2 fL, and mean corpuscular hemoglobin (MCH) of 27.6 pg. However, during my blood test on November 17 this year, I fo...

Dr. Liao Yaopan reply Family Medicine
It is recommended to consult a hematologist for a comprehensive evaluation of the causes of anemia. Please note that online consultations do not equate to in-person medical visits and cannot provide accurate diagnoses or treatment recommendations. Changhua Hospital cares about yo...

Understanding Elevated Red Blood Cells and Hemoglobin Levels

Elevated red blood cell count at 588, hemoglobin at 18.3, and hematocrit at 54.9 indicate polycythemia. This condition can be caused by various factors, including chronic hypoxia, dehydration, or certain medical conditions such as polycythemia vera. It is important to consult a h...

Dr. Tang Jieru reply Cardiology
Hello A-Qiang: Based on the values you provided, they are indeed elevated. However, laboratory tests are merely a reference, and normal values are determined by human standards. What is more important is whether you have any symptoms, such as shortness of breath. There could also...

Understanding Your Health Check Report: What High RBC and Hematocrit Levels Mean

Hello, doctor. Regarding the health check results: red blood cell count is 555, and hematocrit is 49.7. What do these values signify? Are they indicative of any symptoms or diseases? Thank you!

Dr. Sun Weixu reply Family Medicine
Red blood cell count (RBC) for males is 3.8 million to 6 million cells/mm³, and for females, it is 3.8 million to 5.5 million cells/mm³. The majority of blood's composition consists of red blood cells, which are produced in the bone marrow and then released into the bloodstr...

Understanding Sudden Drops in Hemoglobin Levels: Causes and Solutions

I have always had the habit of donating blood, but since the beginning of this year until recently (the past six months), during the finger prick stage of the interview, I was told that my hemoglobin was insufficient, so I underwent testing. The results are as follows: white bloo...

Dr. Chen Bozhang reply Family Medicine
Dear Ms. Jean, Regarding your recent blood test indicating anemia, here is the analysis: The mean corpuscular volume (MCV) of your red blood cells is 70.40 fL, which is low (normal range is 80-100 fL). Your red blood cell count is 5.10 x 10^6, which is high (normal range is 3.5-...