Severe Anemia: Causes and Treatment Options

Low hemoglobin levels?

Dear Director He,
My father was taken to the emergency room earlier this year due to dizziness, where his hemoglobin was found to be only 3 g/dL, and his white blood cell and platelet counts were also critically low.
The doctor treated him with blood transfusions and steroids, diagnosing him with anemia but unable to determine the cause.
After being discharged, he has been returning for follow-up appointments every two weeks.

A few days ago, my father developed a persistent high fever, and upon being admitted to the hospital, his hemoglobin was measured at only 3.6 g/dL.
After receiving a blood transfusion, his hemoglobin continued to decline, currently at 2.6 g/dL, with white blood cell and platelet counts below normal levels.
We are currently receiving care at a small hospital, and I would like to ask you, Director He, whether my father's symptoms could indicate aplastic anemia.
Would a bone marrow biopsy at a larger hospital be able to further confirm the diagnosis and guide treatment?
I sincerely appreciate your time and response.
Thank you, and I wish you peace and joy.

Erin, 20~29 year old female. Ask Date: 2015/10/09

Dr. He Dongjin reply Cardiology

Hello, please refer to the hematology department of a major hospital, Changhua Hospital, for further care.

Reply Date: 2015/10/09

More Info

Severe anemia, particularly in the context of your father's case, can be a complex and serious condition that requires thorough investigation and management. Based on the information provided, your father's symptoms and laboratory findings suggest he may be experiencing aplastic anemia, a condition where the bone marrow fails to produce sufficient blood cells, leading to low levels of red blood cells, white blood cells, and platelets.

Causes of Severe Anemia
Severe anemia can arise from various causes, including:
1. Bone Marrow Disorders: Conditions like aplastic anemia, leukemia, and myelodysplastic syndromes can lead to inadequate blood cell production.

2. Nutritional Deficiencies: Deficiencies in iron, vitamin B12, or folate can result in anemia.

3. Chronic Diseases: Chronic kidney disease, liver disease, and autoimmune disorders can affect red blood cell production.

4. Hemolysis: Conditions that cause the destruction of red blood cells can lead to anemia.

5. Blood Loss: Acute or chronic blood loss from gastrointestinal bleeding, heavy menstruation, or trauma can result in anemia.

Diagnosis
To determine the specific cause of your father's anemia, a comprehensive evaluation is necessary. This typically includes:
- Complete Blood Count (CBC): To assess levels of hemoglobin, white blood cells, and platelets.

- Bone Marrow Biopsy: This is a critical test for diagnosing aplastic anemia and other bone marrow disorders. It involves taking a sample of bone marrow, usually from the hip bone, to examine the cells and assess the marrow's ability to produce blood cells.

- Additional Tests: Depending on initial findings, tests for viral infections (like hepatitis or HIV), autoimmune disorders, and genetic testing may be warranted.

Treatment Options
The treatment for severe anemia, particularly aplastic anemia, can vary based on the underlying cause and severity of the condition:
1. Blood Transfusions: These can provide immediate relief for low hemoglobin levels but are not a long-term solution.

2. Medications: Corticosteroids and immunosuppressive therapy (such as antithymocyte globulin) may be used to manage aplastic anemia by suppressing the immune system's attack on the bone marrow.

3. Bone Marrow Transplant: For severe cases, especially in younger patients with a matched donor, a bone marrow transplant may be the best option. This procedure replaces the damaged bone marrow with healthy marrow from a donor.

4. Supportive Care: This includes managing symptoms, preventing infections, and addressing any complications that arise from low blood cell counts.

Next Steps
Given your father's critical condition, it is advisable to seek care at a larger medical facility where specialized hematology services are available. A bone marrow biopsy can be performed there to confirm the diagnosis and guide treatment. It is essential to act promptly, as severe anemia can lead to life-threatening complications, including infections and bleeding.

In summary, your father's symptoms and lab results are concerning for aplastic anemia or another serious hematologic condition. A thorough evaluation, including a bone marrow biopsy, is crucial for accurate diagnosis and effective treatment. Please ensure that he receives the necessary care as soon as possible, and do not hesitate to ask healthcare providers about any concerns you may have regarding his treatment plan.

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