Low Hemoglobin Levels: Symptoms, Treatment, and Next Steps

Understanding the Health Check Report dated February 27, 2023?

I would like to understand how to treat my current hemoglobin level of 8.2.
My lab results show RBC 4.18, Hgb 8.2, Hct 29.6, MCV 70.8, MCH 19.6, and MCHC 27.7.
I often experience dizziness, lightheadedness, fatigue, low mood, significant hair loss, heavy menstrual periods with clots, dysmenorrhea, gastroesophageal reflux, and bloating.
I have had an ultrasound in the gynecology department, which showed no issues.
Additionally, I have been receiving psychiatric treatment for 4-5 years for depression, bipolar disorder, and panic disorder.
Since my diagnosis at the end of September last year, I have been experiencing shortness of breath, dry cough, and phlegm.
I would like to know which department I should consult for further examination or treatment.
Currently, my doctor has prescribed iron supplements for one month, and I will have a follow-up check after three months.
I would appreciate any advice.
Thank you!

Liao Coco, 40~49 year old female. Ask Date: 2023/03/04

Dr. Lin Wufu reply Internal Medicine

Hello, the issues you mentioned involve several different specialties.
For anemia, please continue taking iron supplements.
Heavy menstrual flow may be a cause of iron deficiency anemia, so please consult with an obstetrician-gynecologist to see if medication adjustments can help regulate your menstrual flow.
For gastrointestinal symptoms, you should see a gastroenterologist.
Continue your treatment for psychiatric symptoms with a psychiatrist.
After your diagnosis is confirmed, you may consider visiting a follow-up clinic for respiratory symptoms related to COVID-19.
Thank you.

Reply Date: 2023/03/04

More Info

Low hemoglobin levels, particularly at 8.2 g/dL, indicate a significant degree of anemia, which can lead to various symptoms and health complications. Your reported symptoms, including dizziness, fatigue, mood swings, heavy menstrual bleeding, and gastrointestinal issues, suggest that your anemia may be affecting your overall health and quality of life.

Understanding Your Condition
Anemia is classified based on the size and color of red blood cells. In your case, the low MCV (Mean Corpuscular Volume) of 70.8 fL and low MCH (Mean Corpuscular Hemoglobin) of 19.6 pg indicate microcytic anemia, which is often due to iron deficiency. The low MCHC (Mean Corpuscular Hemoglobin Concentration) of 27.7 g/dL further supports this diagnosis.
Common causes of microcytic anemia include:
1. Iron Deficiency Anemia: This is the most prevalent type and can result from inadequate dietary intake, chronic blood loss (such as heavy menstrual periods), or malabsorption issues.

2. Thalassemia: A genetic disorder affecting hemoglobin production, which can also lead to microcytic anemia.

3. Chronic Disease: Conditions like chronic inflammation can also affect red blood cell production.

Symptoms of Low Hemoglobin
The symptoms you are experiencing, such as dizziness, fatigue, and mood changes, are common in individuals with anemia. The body is not receiving enough oxygen due to the low hemoglobin levels, which can lead to:
- Fatigue and Weakness: Reduced oxygen delivery to muscles and tissues.

- Dizziness or Lightheadedness: Especially when standing up quickly.

- Shortness of Breath: This can occur during physical activity or even at rest in severe cases.

- Pale Skin: A result of reduced red blood cells.

- Heart Palpitations: The heart may work harder to pump blood.

Next Steps for Treatment
1. Iron Supplementation: Since your doctor has already prescribed iron supplements, it’s crucial to adhere to this treatment. Iron supplements typically take several weeks to months to improve hemoglobin levels, and it’s essential to follow up with your doctor after three months of treatment to assess your progress.

2. Dietary Changes: Incorporate iron-rich foods into your diet, such as red meat, poultry, fish, lentils, beans, leafy greens, and fortified cereals. Pairing these with vitamin C-rich foods (like oranges or bell peppers) can enhance iron absorption.

3. Monitoring Symptoms: Keep track of your symptoms, especially any worsening of fatigue, shortness of breath, or changes in your menstrual cycle. If you experience significant changes, it’s important to consult your healthcare provider.

4. Further Investigations: Given your history of heavy menstrual bleeding and gastrointestinal symptoms, it may be worthwhile to investigate potential sources of chronic blood loss. This could involve:
- Gynecological Evaluation: To assess for conditions like fibroids or endometriosis that could be contributing to heavy menstrual bleeding.

- Gastrointestinal Evaluation: If gastrointestinal symptoms persist, consider screening for conditions like ulcers or other sources of bleeding.

5. Mental Health Support: Since you are also managing mental health conditions, it’s important to maintain communication with your mental health provider. Anemia can exacerbate feelings of fatigue and depression, so addressing both physical and mental health is crucial.

Conclusion
In summary, your low hemoglobin level requires attention and a multi-faceted approach to treatment. Continue with the iron supplements as prescribed, make dietary adjustments, and monitor your symptoms closely. If your symptoms worsen or do not improve, further evaluations may be necessary to identify any underlying causes of your anemia. Regular follow-ups with your healthcare provider will be essential in managing your condition effectively.

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