This is with reference to a patient suffering from low hemoglobin (as low as 4-5) for over a decade. With blood transfusion or medication (including some injections etc.), the hemoglobin rises slowly to 7-8-9 but then again has a tendency to fall back. What could be the reason?
In case of anemia, a logic diagnostic patway must be started:
1. What are the age and sex of the patient?
2. Is this anemia regenerative (increased reticulocytes count) or hypo-regenerative (decreased reticulocytes count)?
3. What are the morphological features of anemia? Normo-, macro (megalo)-, microcytic? Normo-, hypochromic?
4. What are the biochemical parameters associated with? (haptoglobin, LDH, bilirubin)
5. Iron balance? B12 and folate?
6. It is possible to postulate (or exclude) a chronic disorder? (Tumor, inflammation, infection; autoimmune diseases)
7. Are the other cellular lines involved? (cytopenia; dysplasia)
Based on the above results, a bone marrow aspiration could be performed, to check (in primis) for an erythroblastopenic situation (Diamond-Blackfan anemia if case of paediatric patient; tymoma; idiopathic pure red cells aplasia and other in case of adult patient).
There is no details about the patient. What investigations done over the years, what are additional points in history. Simple answer is it is likely the cause of anemia has not been identified and therefore anemia is recurring despite transfusion or medication over the years. Patient requires methodical work up to determine aetiology and specific/curative treatment thereafter if any.
Consult any hematologist who can offer detailed work up.
I agree with the need to consult a hematologist. Bone marrow could well be involved.
Interestingly, the individual apparently has been having this process "over a decade". A hematologist
would also need to know not only about the red blood cells, but white blood cells, and platelets.
Consult essential.
Dennis
Dennis Mazur
The two reasons of this low hemoglobin are : Colon Cancer and leukaemia
A low haemoglobin is an indicator of anaemia. The causes of anaemia are numerous such as:
1. Inadequate food
2. Defected absorption due to problem of the digestive system
3. Excessive loss of blood due to infection, bleeding
4. Malignant diseases
If this conditions persists for short time few weeks or few months, then a thorow investigation is required. We should exclude malignancy, parasitic infection and leukaemias
Thanks @ Gourab Dewan , @ Dennis Mazur , @ Moise Muhindo Valimungighe , @ Omran S Habib
Investigation like basic CBC ,ESR, hemolytic profile , stool for parasite so many one by one
In case of anemia, a logic diagnostic patway must be started:
1. What are the age and sex of the patient?
2. Is this anemia regenerative (increased reticulocytes count) or hypo-regenerative (decreased reticulocytes count)?
3. What are the morphological features of anemia? Normo-, macro (megalo)-, microcytic? Normo-, hypochromic?
4. What are the biochemical parameters associated with? (haptoglobin, LDH, bilirubin)
5. Iron balance? B12 and folate?
6. It is possible to postulate (or exclude) a chronic disorder? (Tumor, inflammation, infection; autoimmune diseases)
7. Are the other cellular lines involved? (cytopenia; dysplasia)
Based on the above results, a bone marrow aspiration could be performed, to check (in primis) for an erythroblastopenic situation (Diamond-Blackfan anemia if case of paediatric patient; tymoma; idiopathic pure red cells aplasia and other in case of adult patient).
As fellow colleagues pointed out, one will need more clinical data and at least a blood picture and retics before venturing into the possibilities.
If one would know the age and sex of the patient, and more detailed history and examination including the presence of organomegaly. This would be a good starting point. A simple blood count, blood film and reticulocyte count would put the physician in charge on the right track, before considering further testing or investigations.
Stool occult blood test and reticulocytes count will be needed after providing all needed details related to patient as stated by Antonio; a lot of information is missing that will help providing evidence-based suggestions.
First diagnose the condition the is responsible for low Hb% and give the treatment accordingly
Hi Dr Shanker
Have you finally solved the diagnostic path for your patient? What was the diagnosis? Is it still anemic?
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