Decreased Hemoglobin and Hematocrit Levels: Causes and Solutions

Hemoglobin/Hematocrit Average Hemoglobin/Hematocrit Ratio Decrease

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 found that my hemoglobin and hematocrit levels have significantly decreased, with hemoglobin at 10.4 g/dL, hematocrit at 32.1%, MCV at 75.9 fL, and MCH at 24.6 pg.
The ENT specialist suggested that I might have thalassemia and advised me to eat apples daily to improve my condition.

Over the past two years, I have changed my routine to a night shift schedule, and my sleep disturbances have worsened.
It takes me about two hours to fall asleep (two years ago, I visited a psychiatrist who taught me relaxation techniques and prescribed relaxation medication, but I felt it was not helpful, so I stopped going).
Additionally, I experience dizziness and headaches after menstruation, which have persisted for more than two weeks this month (although the doctor mentioned that anemia is unrelated to menstrual flow).

I also have nasal congestion when trying to sleep, making it difficult to breathe (both sides of my nose get blocked regardless of whether I lie on my left or right side; I can only breathe somewhat when lying flat).
Generally, I feel normal when sitting or standing, but occasionally one side gets congested, and I struggle to breathe in crowded or poorly ventilated places.
I would like to ask what possible causes there could be for these symptoms, as my family and friends are insisting that I continuously consume iron-rich foods to improve my blood levels, but I am certain that my diet has not changed over the past two years.

Cha Cha Cha, 20~29 year old female. Ask Date: 2017/11/27

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 your health.

Reply Date: 2017/11/27

More Info

Understanding decreased hemoglobin and hematocrit levels is crucial for identifying potential health issues and implementing appropriate solutions. Hemoglobin (Hb) is a protein in red blood cells responsible for transporting oxygen throughout the body, while hematocrit (Hct) measures the proportion of blood volume that is occupied by red blood cells. When these levels drop, it can lead to a condition known as anemia, which can manifest in various symptoms such as fatigue, weakness, and shortness of breath.

In your case, the decrease in hemoglobin from 11.5 g/dL to 10.4 g/dL and hematocrit from 35.1% to 32.1% over two years indicates a worsening of your anemia. The average corpuscular volume (MCV) and average corpuscular hemoglobin (MCH) values you provided also suggest that your red blood cells are smaller and contain less hemoglobin than normal, which is characteristic of microcytic anemia, often associated with iron deficiency or thalassemia (Mediterranean anemia).

Several factors could contribute to your decreased hemoglobin and hematocrit levels:
1. Dietary Deficiencies: A lack of iron, vitamin B12, or folate in your diet can lead to anemia. Even if your dietary habits have not changed significantly, the body's absorption of these nutrients can be affected by various factors, including gastrointestinal health.

2. Menstrual Blood Loss: You mentioned experiencing heavy menstrual bleeding, which can significantly contribute to iron deficiency anemia. Although your doctor suggested that your anemia is unrelated to menstrual blood loss, it is essential to consider this factor, especially if you experience symptoms like dizziness and headaches during your menstrual cycle.

3. Chronic Conditions: Conditions such as chronic kidney disease, inflammatory diseases, or infections can lead to anemia of chronic disease. If you have any underlying health issues, they could be contributing to your anemia.

4. Sleep Disorders: Your reported sleep disturbances may also play a role. Poor sleep can lead to fatigue and exacerbate feelings of weakness associated with anemia. Additionally, sleep apnea can cause intermittent hypoxia, which may further affect red blood cell production.

5. Bone Marrow Function: If there are issues with your bone marrow's ability to produce red blood cells, this could lead to decreased hemoglobin and hematocrit levels. This is less common but should be evaluated if other causes are ruled out.

To address your anemia, consider the following steps:
- Dietary Adjustments: Incorporate iron-rich foods into your diet, such as red meat, poultry, fish, lentils, beans, and fortified cereals. Pairing these with vitamin C-rich foods (like citrus fruits) can enhance iron absorption.

- Medical Evaluation: Since your symptoms have persisted and worsened, it is crucial to follow up with your healthcare provider. They may recommend further testing, such as a complete blood count (CBC), iron studies, and possibly a referral to a hematologist for specialized evaluation.

- Menstrual Management: If heavy menstrual bleeding is a concern, discussing this with your gynecologist may lead to treatment options that can help manage your symptoms and reduce blood loss.

- Sleep Hygiene: Addressing your sleep issues is vital. Consider consulting a sleep specialist or a healthcare provider who can help you explore treatment options for your sleep disturbances.

- Regular Monitoring: Keep track of your hemoglobin and hematocrit levels through regular blood tests to monitor your progress and response to any interventions.

In conclusion, while your decreased hemoglobin and hematocrit levels are concerning, understanding the potential causes and implementing appropriate dietary and lifestyle changes, along with medical evaluation, can help improve your condition. It is essential to work closely with your healthcare provider to develop a tailored plan that addresses your specific needs and symptoms.

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