Low Hemoglobin: Causes and Solutions for Symptoms Like Dizziness and Fatigue - Family Medicine

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A hemoglobin level of only 10 g/dL may lead to symptoms such as dizziness, headaches, blurred vision, generalized weakness, and loss of appetite?


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 results showed that her hemoglobin level was low at 9, so the doctor referred her to an endocrinologist.
It was discovered that her liver enzymes were elevated, twice the normal level (99), so they arranged for tests including hepatitis A, B, and C, an endoscopy, abdominal ultrasound, and a brain MRI.
The results showed that her stomach was healthy, the abdominal ultrasound revealed a 2 cm cyst on the liver (which the doctor said was not a concern), the hepatitis tests were negative, and the brain MRI was normal.
Since the doctor could not find the cause, and my mother experiences severe pain during her menstrual cycle, I scheduled an appointment with a gynecologist.
The doctor suggested that the low hemoglobin might be due to adenomyosis and fibroids, so we quickly arranged for surgery to remove her uterus and ovaries (my mother was born in 1965) since she has not reached menopause and her menstrual flow has been increasing.
We decided to follow the doctor's advice.
At the end of May 2019, her uterus was removed, and she is currently recovering well.
However, after stopping the pain medication, her symptoms began to reappear, indicating that the underlying issue has not been resolved.
Last week, on June 21, my mother had another blood test to check if her hemoglobin had returned to normal.
The report indicated that her hemoglobin is slowly recovering to a level of 11, but the lab noted that her liver enzymes remain elevated.
We are now at a loss about what to do next.
Since her surgery on May 28, she has had a poor appetite, general weakness, headaches, and dizziness, leading to significant weight loss.
It is really heartbreaking to see her suffering.
She feels very weak and is in pain.
Is there any further testing that can be done? The doctors at the hospital have mentioned iron deficiency, and although she has received some iron supplementation, her overall weakness continues to cause her distress.
We are truly at a dead end and are wondering if you could provide any assistance.

Miss Chen, 30~39 year old female. Ask Date: 2019/06/27

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 necessary to consider whether the problem is related to a psychosomatic disorder, which falls under psychiatric concerns.

3.
If you still have uncertainties, please discuss them in detail with your primary care physician before making any decisions.

Reply Date: 2019/06/27

More Info


Understanding low hemoglobin levels and their associated symptoms is crucial, especially when dealing with complex health issues like those your mother is experiencing. Low hemoglobin (Hb) levels can lead to various symptoms, including dizziness, fatigue, weakness, and even cognitive disturbances like blurred vision. In your mother's case, her hemoglobin level was critically low at 9 g/dL, which is indicative of anemia. Anemia can arise from several causes, including iron deficiency, chronic disease, or bone marrow disorders.

Given your mother's symptoms of abdominal discomfort, dizziness, and overall weakness, it was prudent for the medical team to conduct a comprehensive evaluation. The elevated liver enzymes (with a G.O.T. of 99) alongside her anemia suggest that there may be an underlying issue affecting both her liver and her blood production. The fact that her liver ultrasound showed a 2 cm cyst, which the doctor deemed benign, is a positive sign, but it doesn't rule out other liver-related issues that could contribute to her symptoms.

The surgical intervention to remove her uterus and ovaries was likely aimed at addressing the source of her menstrual pain and potential blood loss, which could have contributed to her anemia. However, it is concerning that her symptoms have persisted post-surgery, indicating that the root cause of her fatigue and weakness may not have been fully resolved.

The recovery of her hemoglobin levels to 11 g/dL is a step in the right direction, but the persistent high liver enzymes and her ongoing symptoms warrant further investigation. It is essential to consider the following:
1. Follow-Up Testing: Given the complexity of her case, it may be beneficial to conduct additional tests, including a complete blood count (CBC) to monitor her hemoglobin and other blood parameters, liver function tests, and possibly a ferritin test to assess her iron stores.
2. Nutritional Assessment: Since iron deficiency has been mentioned, it would be wise to evaluate her dietary intake and consider iron supplementation if necessary. Foods rich in iron, such as red meat, beans, lentils, and fortified cereals, should be included in her diet. Vitamin C can enhance iron absorption, so pairing iron-rich foods with vitamin C sources (like citrus fruits) is beneficial.

3. Liver Function Monitoring: Continuous monitoring of liver function is crucial. If liver enzymes remain elevated, further investigations such as a liver biopsy or additional imaging studies may be warranted to rule out conditions like fatty liver disease, hepatitis, or other liver pathologies.

4. Addressing Symptoms: For her ongoing symptoms of fatigue and weakness, a multidisciplinary approach may be required. This could involve consultations with a hematologist for her anemia, a gastroenterologist for her liver issues, and possibly a nutritionist to optimize her diet for recovery.

5. Psychosocial Support: Chronic illness can take a toll on mental health. Ensuring that your mother has access to psychological support or counseling can help her cope with the emotional aspects of her health challenges.

In summary, while your mother has made some progress in her hemoglobin levels, the persistence of her symptoms and the elevated liver enzymes indicate that further evaluation and management are necessary. It's essential to maintain open communication with her healthcare providers, ensuring that all aspects of her health are being addressed holistically. Regular follow-ups and a proactive approach to her care will be key in navigating her recovery journey.

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