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Forum Name: Hematology Topics

Question: iron level dropped from 8.2 to 5.9 in 3months


 harry1967 - Sat Jan 20, 2007 3:25 pm

My Grandmother is 84 years old and has been anemaic for several years. She is a diebetic who takes insulin.
Over the last 12 months she has several had a UTI (6months ago), Vertigo, chest infections.
Her last blood test showed a haemoglobin level of 8.2 3 months ago but this has dropped to 5.9. I thought giving her a liquid iron would help her anemia but obviously hasn't. She is now on 3 Ferrous Sulphate a day. She seems to have developed an UTI this week to for which she is on Cefelaxin 250mg. I tested her urine at home with a dipstick and there a high concentrate of blood in the urine 50 and the Specific Gravity is 1.030. There is a presence of Leucocytes too at 125++. Can any one explain why her haemoglobin would have dropped so quickly? I forgot to mention her staple diet is 1 weetabix for breakfast, 2 chappatis at lunch and 2 at dinner. (chappatis are small flat breads made of just wheat and water).

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 Dr. Chan Lowe - Tue Jan 23, 2007 8:42 pm

User avatar A hemaglobin level of 5 is significantly low. I suspect that your grandmother's doctor will want to follow this up.

There are several causes of a falling hemoglobin levels:

-Iron deficiency leading to difficulty making new red blood cells.

-Ongoing bleeding can also cause this. If bleeding is faster than production, the hemoglobin level drops. I would be a little concerned about this in your case.

-Aditionally, chronic illness can lead to decreased production of red blood cells.

A few tests can be helpful to sort this out. First, I would suggest looking for any sources of bleeding, such as blood in the stool via a guaiac test. Also, blood in the urine can be unseen but tested for with a urinalysis.

A reticulocyte count can help to determine if the bone marrow is producing new blood cells or not. This will help narrow the causes. Also, looking at various red cell indicators such as mean corpustular volume (MCV) can help. If iron deficiency is possible, iron studies can be done to measure iron stores.

I would most definitely recommend that this be followed and evaluated. Keep us updated.

Hope this helps.
 harry1967 - Tue Feb 20, 2007 3:39 pm

Hi firstly thanks for your response.
A week after posting a senior hospital physicain visited Gran and said we should stop the mild Asprin she was taking and that he did not want to admit her for a transfusion as there were rsiks involved at her age.
He said we should continue with three ferrous sulphate and repeat the blood tests.
This we have done and the Hb level has now risen to 8.6 (within 3 weeks after first test when it was 5.2). Unfortunately Gran has just got another UTI (2nd one this year). She is on Cefalaxin 500mg this time.
Her other blood results are
Wbcs 17.0
Rbcs 3.95
Hct 0.280
MCV 70.9
MCH 21.8
MCHC 30.7
RDW 33.1
Plt 740
Neuthrophils 15.21
Lymphocytes 0.96
Ferritin 46
RU Creatine 10.9
RU MALbumin 27
RU MAlb/Creat 2.5

I know most of these are low or high figures andwas wondering if they so extreme that they should be a worry to me?

Regards Harry.

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